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Albuminuria predicts cardiovascular events independently of left ventricular mass in hypertension: a LIFE substudy

Journal of Human Hypertension volume 18, pages 453–459 (2004)Cite this article

Abstract

We wanted to investigate whether urine albumin/creatinine ratio (UACR) and left ventricular (LV) mass, both being associated with diabetes and increased blood pressure, predicted cardiovascular events in patients with hypertension independently. After 2 weeks of placebo treatment, clinical, laboratory and echocardiographic variables were assessed in 960 hypertensive patients from the LIFE Echo substudy with electrocardiographic LV hypertrophy. Morning urine albumin and creatinine were measured to calculate UACR. The patients were followed for 60±4 months and the composite end point (CEP) of cardiovascular (CV) death, nonfatal stroke or nonfatal myocardial infarction was recorded. The incidence of CEP increased with increasing LV mass (below the lower quartile of 194 g to above the upper quartile of 263 g) in patients with UACR below (6.7, 5.0, 9.1%) and above the median value of 1.406 mg/mmol (9.7, 17.0, 19.0%***). Also the incidence of CV death increased with LV mass in patients with UACR below (0, 1.4, 1.3%) and above 1.406 mg/mmol (2.2, 6.4, 8.0%**). The incidence of CEP was predicted by logUACR (hazard ratio (HR)=1.44** for every 10-fold increase in UACR) after adjustment for Framingham risk score (HR=1.05***), history of peripheral vascular disease (HR=2.3*) and cerebrovascular disease (HR=2.1*). LV mass did not enter the model. LogUACR predicted CV death (HR=2.4**) independently of LV mass (HR=1.01* per gram) after adjustment for Framingham risk score (HR=1.05*), history of diabetes mellitus (HR=2.4*) and cerebrovascular disease (HR=3.2*). *P<0.05, **P<0.01, ***P<0.001. In conclusion, UACR predicted CEP and CV death independently of LV mass. CV death was predicted by UACR and LV mass in an additive manner after adjustment for Framingham risk score and history of CV disease.

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Acknowledgements

We thank Mary Paranicas, BA, Shonna Cohen, BA and Andreas Moan, MD, for their invaluable assistance with study coordination. Furthermore, we thank the LIFE echocardiography study investigators:

This work was supported in part by grants from Merck & Co., Inc., West Point, PA, USA.

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Authors and Affiliations

  1. Glostrup University Hospital, Glostrup, Denmark

    M H Olsen, K Wachtell & H Ibsen

  2. The Weill Medical College of Cornell University, New York, NY, USA

    J N Bella, V Palmieri & R B Devereux

  3. Haukeland Hospital, Bergen, Norway

    E Gerdts

  4. Helsinki University Hospital, Helsinki, Finland

    G Smith

  5. Ullevaal University Hospital, Oslo, Norway

    M S Nieminen

  6. Sahlgrenska University Hospital-Östra, Sweden

    B Dahlöf

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  1. M H Olsen
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Correspondence to M H Olsen.

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Olsen, M., Wachtell, K., Bella, J. et al. Albuminuria predicts cardiovascular events independently of left ventricular mass in hypertension: a LIFE substudy. J Hum Hypertens 18, 453–459 (2004). https://doi.org/10.1038/sj.jhh.1001711

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