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This Article Full Text Full Text (PDF) All Versions of this Article: ASN.2008010038v1 19/10/1983    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Forman, J. P. Articles by Curhan, G. C. Search for Related Content PubMed PubMed Citation Articles by Forman, J. P. Articles by Curhan, G. C. Related Collections Related Article

Higher Levels of Albuminuria within the Normal Range Predict Incident Hypertension

John P. Forman^*, Naomi D.L. Fisher, Emily L. Schopick^* and Gary C. Curhan^*

^* Renal Division and Channing Laboratory and Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts

Correspondence: Dr. John P. Forman, Channing Laboratory, 3rd floor; 181 Longwood Avenue, Boston, MA 02115. Phone: 617-525-2092; Fax: 617-525-2008; E-mail: jforman{at}partners.org

Received for publication January 11, 2008. Accepted for publication April 24, 2008.

Higher levels of albumin excretion within the normal range are associated with cardiovascular disease in high-risk individuals. Whether incremental increases in urinary albumin excretion, even within the normal range, are associated with the development of hypertension in low-risk individuals is unknown. This study included 1065 postmenopausal women from the first Nurses’ Health Study and 1114 premenopausal women from the second Nurses’ Health Study who had an albumin/creatinine ratio <25 mg/g and who did not have diabetes or hypertension. Among the older women, 271 incident cases of hypertension occurred during 4 yr of follow-up, and among the younger women, 296 incident cases of hypertension occurred during 8 yr of follow-up. Cox proportional hazards regression was used to examine prospectively the association between the albumin/creatinine ratio and incident hypertension after adjustment for age, body mass index, estimated GFR, baseline BP, physical activity, smoking, and family history of hypertension. Participants who had an albumin/creatinine ratio in the highest quartile (4.34 to 24.17 mg/g for older women and 3.68 to 23.84 mg/g for younger women) were more likely to develop hypertension than those who had an albumin/creatinine ratio in the lowest quartile (hazard ratio 1.76 [95% confidence interval 1.21 to 2.56] and hazard ratio 1.35 [95% confidence interval 0.97 to 1.91] for older and younger women, respectively). Higher albumin/creatinine ratios, even within the normal range, are independently associated with increased risk for development of hypertension among women without diabetes. The definition of normal albumin excretion should be reevaluated.

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