Abstract 16182: The Association of Glomerular Filtration Rate and Albuminuria With Incident Hypertension: The Atherosclerosis Risk in Communities (ARIC) Study
Introduction: Basic studies suggest that kidney dysfunction predates essential hypertension. However, only two epidemiological studies evaluated the most important kidney measures, estimate glomerular filtration rate (eGFR) and albuminuria, simultaneously regarding their associations with incident hypertension, with conflicting results.
Hypothesis: Both low eGFR and high albuminuria are associated with incident hypertension independently of each other and potential confounders.
Methods: We studied 5,373 participants of the ARIC Study without a history of cardiovascular disease or prevalent hypertension at baseline (4th ARIC visit, 1996–98), defined as blood pressure ≥140/90 mmHg or self-reported medications for hypertension. Incident hypertension was defined as diagnosed hypertension or medications for hypertension self-reported via annual phone calls. We used Cox proportional hazards models to estimate hazard ratios (HRs) of incident hypertension by categories of eGFR and urine albumin:creatinine ratio (UACR).
Results: Participants who were excluded due to hypertension at baseline had lower eGFR and higher albuminuria compared with those who were included in this analysis. A total of 2,433 cases of incident hypertension developed during a median follow-up of 7.4 years (incidence rate 69/1,000 person-years). Adjusted HR of incident hypertension rose progressively across categories of UACR ≥5 mg/g (Table). In contrast, no significant HRs were observed for eGFR. Further adjustment for each kidney measure did not alter the results. Importantly, similar results were obtained even when participants with prehypertension (120–139/80–89 mmHg) were excluded.
Conclusions: Elevated albuminuria even in the range currently considered normal (<30 mg/g), but not eGFR, was associated with incident hypertension in a graded manner, suggesting that kidney or vasculature damage expressed as albuminuria is a predictor of incident hypertension.
- © 2010 by American Heart Association, Inc.