Albuminuria in normotensive and hypertensive individuals attending offices of general practitioners

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Abstract
Objective To investigate the rate of albumin excretion and the prevalence of albuminuria in hypertensive individuals relative to the normotensive population, and to clarify the quantitative importance of confounding variables. Design and methods We examined the morning urines of all consecutive non-diabetic and diabetic hypertensive patients (n=631; 371 women, 260 men) attending the offices of five general practitioners in a circumscribed geographical area during a 4-month period. To obtain a normotensive control population, all consecutive visitors (n=375; 217 women, 158 men) were also examined. Urinary albumin excretion was assessed by kinetic nephrelometry in morning urine samples. Results The median albumin excretion rate was 4.3 μg/ml (range 1.9-112) in normotensive individuals; 3.4μg/ml (1.9-1440) in hypertensive and 3.6μg/ml (1.9-2790) in diabetic patients (n=189; 115 women, 74 men). The overall prevalence of albuminuria above 20μg/ml was 4% in normotensive individuals, 10% in hypertensive patients and 17% in diabetic patients. The proportion of patients with higher-grade albuminuria (> 50μg/ml) was 1% among the normotensive subjects aged below 60 years and 2% in those aged above 60 years; the respective values in hypertensive patients were 3 and 6% and in diabetic patients 8 and 13%. The multivariate regression analysis showed a significant correlation between albuminuria and smoking (P< 0.0001), the presence of hypertension (P< 0.001), the current level of systolic blood pressure (P<0.01) and age (0.031), but not sex or body mass index. Conclusions The present study confirms a higher prevalence of albuminuria above 20 ng/ml in individuals with primary hypertension and diabetes mellitus compared with that in normotensive subjects, despite similar median albumin excretion rates. However, the excess of prevalence is moderate. Smoking, advanced age and current level of systolic blood pressure are the important determinants

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