Distinct Urinary Protein Signatures in Adolescent Blood Pressure Phenotypes

Q: What does this research mean for the field?

Adolescent elevated blood pressure phenotypes exhibit distinct urinary inflammatory protein signatures, with isolated diastolic hypertension specifically associated with elevated serum amyloid A and combined systolic-diastolic hypertension associated with elevated C-reactive protein. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Loreen Thürmann; Anke Seegebarth; Andrea von Berg; Dietrich Berdel; Sibylle Koletzko; Joachim Heinrich; Tamara Schikowski; Irina Lehmann; Marie Standl; Saskia Trump

doi:10.1161/circresaha.126.328246

July 22, 2026Circulation ResearchOpen Access

Distinct Urinary Protein Signatures in Adolescent Blood Pressure Phenotypes

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Why the study?

Are elevated blood pressure phenotypes in adolescents associated with distinct urinary inflammatory protein signatures?

Key Points

To determine whether distinct elevated blood pressure subphenotypes in adolescents are associated with specific urinary inflammatory protein profiles reflecting subclinical vascular and renal processes.
Analyzed spot urine samples and blood pressure measurements in 1502 15-year-old participants from the GINIplus birth cohort study.
Quantified 10 vascular inflammatory proteins normalized to urinary creatinine and classified participants into normotensive (<P90th) and elevated blood pressure subphenotypes (≥P95th) according to 2023 European Society of Hypertension guidelines.
Estimated associations between blood pressure phenotypes and high protein concentrations (≥P90th) using multivariate logistic regression adjusted for directed acyclic graph-derived confounders.
Isolated diastolic hypertension was associated with elevated serum amyloid A (≥P90th frequency: 23.0% vs 9.2% in normotensive controls; adjusted OR, 2.25 [95% CI, 1.31–3.88], P=0.003 for detectable levels).
Combined systolic and diastolic hypertension was specifically associated with elevated C-reactive protein (≥P90th frequency: 25.5% vs 8.8% in normotensives; continuous regression b [SE]=1.63[0.74], P=0.028), significantly differing from isolated diastolic hypertension (P=0.019).
Before correction for multiple testing, isolated diastolic hypertension was associated with MMP-9 (raw P=0.016), and combined systolic and diastolic hypertension was associated with VCAM-1 (raw P=0.033) and myoglobin (raw P=0.034).

Structured PICO

Are elevated blood pressure phenotypes in adolescents associated with distinct urinary inflammatory protein signatures?

P

Population

15-year-old adolescents from the GINIplus birth cohort study (n=1502 analyzed). Exclusions: physician-diagnosed hypertension at the 20-year follow-up or a urinary tract infection within 4 weeks before sampling.

C

Comparator

Normotensive adolescents (blood pressure <P90th)

O

Outcome

High (≥P90th) urinary concentrations of 10 inflammatory protein markers (including SAA, CRP, MMP-9, VCAM-1)surrogate

Limitations

BP measurements and urine sampling were performed at a single visit
Subgroup sizes were modest
Classifications reflect elevated BP rather than confirmed hypertension
Data on kidney or vascular function were unavailable
Spot urine samples may not have fully captured low-grade proteinuria
Cannot determine whether elevated CRP/SAA reflects systemic or local inflammation
Observational study design precludes inferring causal mechanisms

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Implication

Elevated blood pressure phenotypes in adolescents, particularly isolated diastolic hypertension, are associated with distinct subclinical urinary inflammatory profiles such as elevated SAA, suggesting early vascular dysfunction prior to formal hypertension diagnosis.

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Cite This Study

Thürmann et al. (2026) studied this question.

synapsesocial.com/papers/6a630370395161722cd16da6 https://doi.org/10.1161/circresaha.126.328246

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Distinct Urinary Protein Signatures in Adolescent Blood Pressure Phenotypes

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Distinct Urinary Protein Signatures in Adolescent Blood Pressure Phenotypes

Figures

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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