Mikroalbuminuri er associeret med firedobbelt risiko for iskaemisk hjertesygdom blandt hypertensive

INTRODUCTION: The urinary excretion of albumin is positively correlated to the presence of ischaemic heart disease and atherosclerotic risk factors in subjects with arterial hypertension. The aim of this population-based, follow-up study of hypertensive patients was to assess the predictive impact of a slightly elevated urinary excretion of albumin, i.e. microalbuminuria, on ischaemic heart disease.

MATERIAL AND METHODS: In 1983-1984, blood pressure, the albumin/creatinine concentration ratio in a morning urine sample, total and HDL cholesterol in plasma, body mass index, and smoking habits were measured in a population of 2085 men and women aged 30-60 years. Exclusion criteria were ischaemic heart disease, diabetes mellitus, and renal or urinary tract disease. Untreated hypertension or borderline hypertension (a systolic blood pressure above 140 mmHg and/or a diastolic blood pressure above 90 mmHg) were found in 204 of the participants, who were followed up until 1993 with respect to the development of ischaemic heart disease through the Danish Hospital Register and Death Certificate Register.

RESULTS: Over 1978 person-years, 18 participants (9%) developed ischaemic heart disease. Microalbuminuria, defined as a urinary albumin/creatinine ratio above the upper decile in the hypertensive population under study (1.07 mg/mmol), was the strongest predictor of ischaemic heart disease with a relative risk (95% confidence interval) of 4.2 (1.5-11.9) (p = 0.006). When adjusted for all other variables, including age and sex, the relative risk was 3.5 (1.0-12.1) (p = 0.05).

DISCUSSION: Microalbuminuria is associated with a fourfold increased risk of ischaemic heart disease in subjects with untreated hypertension or borderline hypertension. Urinary excretion of albumin should perhaps be monitored regularly in the hypertension clinic, and rigorous control of blood pressure and other modifiable atherosclerotic risk factors is to be recommended in hypertensive patients with microalbuminuria.