Key result
Higher urinary albumin excretion in controlled hypertension signals ASCVD risk matching untreated grade 1 hypertension.
Why the study?
Patients treated with antihypertensive medication face residual ASCVD risk despite well-controlled BP, and whether urinary albumin excretion can stratify this risk was unknown.
Does urinary albumin excretion stratify residual ASCVD risk in medicated hypertensive patients with well-controlled blood pressure?
Cohort (n=13,082)
Does urinary albumin excretion stratify residual ASCVD risk in medicated hypertensive patients with well-controlled blood pressure?
Urinary albumin excretion is a useful marker for stratifying residual ASCVD risk in hypertensive patients whose blood pressure is well controlled with medication.
May flag residual ASCVD risk in controlled hypertension; leaves open whether targeting albumin excretion improves outcomes.
BACKGROUND: Patients treated with antihypertensive medication, even those with well controlled blood pressure (BP), are at higher risk for the development of atherosclerotic cardiovascular disease (ASCVD) in comparison to nonhypertensive individuals with optimal risk levels. We hypothesized that this residual risk could be stratified based on urinary albumin excretion (UAE). METHODS: A total of 13 082 middle-aged and older individuals with SBP/DBP of less than 160/100 mmHg and urinary albumin-to-creatinine ratios (UACRs) of less than 300 mg/g, and who were free from ASCVD events, were followed to investigate the incidence of ASCVD. The baseline BP was classified into four categories: normal BP (BP1), high normal BP (BP2), elevated BP (BP3), and grade 1 hypertension (BP4) based on the 2019 Japanese Society of Hypertension guidelines. RESULTS: After an average 10.6 ± 2.6 years of follow-up, the multivariable hazard ratio for the development of ASCVD (n = 994) was already increased in medicated hypertensive patients with BP1 in comparison with untreated individuals with BP1; however, among medicated hypertensive patients, this risk was separated between the UAE groups, which were classified according to the median UACR (male, 15.4 mg/g; female, 19.0 mg/g). In medicated hypertensive patients with any category of BP1-BP3, the adjusted risk of the development of ASCVD in those with lower and higher UACRs was comparable to that observed in untreated individuals in the BP1 and BP4 categories, respectively. CONCLUSION: In medicated patients with well controlled hypertension, UAE is useful for stratifying the residual risk of developing ASCVD in comparison to nonhypertensive individuals with optimal risk levels.
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Kikuchi et al. (2021) conducted a cohort in Hypertension (n=13,082). Urinary albumin excretion (UAE) stratification vs. Untreated individuals or lower UACR was evaluated on Development of atherosclerotic cardiovascular disease (ASCVD). Higher urinary albumin excretion in medicated patients with well-controlled hypertension identified a residual risk of developing ASCVD comparable to that of untreated grade 1 hypertension.
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