Higher Exercise Blood Pressure Is Associated With Increased Urinary Albumin Excretion in Non-Diabetic Population With Non-Elevated Blood Pressure

Objective: Increased urinary albumin excretion (UAE) is a prognostic marker of kidney disease in patients with hypertension or diabetes. An exaggerated blood pressure (BP) response to light exercise is a predictor of future development of hypertension in non-hypertensive individuals. However, the association between exercise BP and UAE in non-diabetic individuals with non-elevated BP remains unclear. We investigated whether higher exercise BP is associated with increased UAE in this population. Design and method: This is a retrospective registry-based observational study. Among non-diabetic individuals with non-elevated resting BP (systolic BP <120 mmHg and diastolic BP <70 mmHg) undergoing routine health screening, treadmill exercise testing and spot urine albumin-to-creatinine ratio (ACR) measurements were available for 8,631 men and women. Participants with abnormal exercise test results or clinical cardiovascular disease were excluded. An exaggerated BP response was defined as an increase in systolic BP >= 20 mmHg at stage 1 of the exercise test. Increased UAE was defined as an ACR >= 30 mg/mmol. Results: The mean age was 48 ± 8 years, and 81% of participants were male. An exaggerated BP response was observed in 25% of subjects, while increased UAE was present in 3%. An exaggerated BP response was independently associated with a higher likelihood of increased UAE (odds ratio 1.51, 95% confidence interval 1.10–2.08; p = 0.01) after adjustment for age, sex, resting systolic BP, body mass index, and hemoglobin A1c. Conclusions: In individuals with non-elevated resting BP, an exaggerated BP response to light exercise was associated with increased UAE. Exercise BP response may serve as a useful marker of masked hypertension and subclinical target organ damage.