The Association Between Stress‐Induced Hyperglycemia Ratio and Increased Urinary Albumin Excretion in Patients With Hypertension: A Population‐Based Study

The stress hyperglycemia ratio (SHR), a novel marker reflecting relative hyperglycemia, has been increasingly recognized for its prognostic value in cardiovascular and metabolic diseases. However, its association with early renal damage in hypertensive patients remains underexplored. This study aims to investigate the independent relationship between SHR and albuminuria in a nationally representative cohort of adults with hypertension. This cross‐sectional analysis included 8732 adults with hypertension from the National Health and Nutrition Examination Survey 2005–2018. Multivariable logistic regression models were used to evaluate the independent association between SHR and albuminuria, with adjustment for demographic, lifestyle, and clinical covariates. Restricted cubic splines (RCS) were employed to model nonlinear relationships. Stratified analyses were conducted across various subgroups. The prevalence of albuminuria was 15%. After full adjustment for confounders, compared to the reference quartile (Q2), the highest SHR quartile was significantly associated with an increased odds of albuminuria (OR: 2.34; 95% CI: 1.62–3.36; p < 0.001). RCS analysis revealed a nonlinear, J‐shaped association between continuous SHR and albuminuria ( p for nonlinearity < 0.001), with risk markedly increasing beyond an SHR of approximately 0.91. Subgroup analyses confirmed the robustness of this association across most strata, including age, gender, BMI, eGFR, diabetes status, and cancer history, with no significant interactions observed (all p ‐interaction > 0.05). In this large, population‐based study, an elevated SHR is significantly and independently associated with a higher prevalence of albuminuria among US adults with hypertension.