title: Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study.
abstract: BACKGROUND
  Several studies have shown that albuminuria is associated with increased risk for fatal and nonfatal cardiovascular events, independent of conventional risk factors. The partition values for urine albumin-creatinine ratio (UACR) used to identify microalbuminuria have been based on studies that predicted risk in diabetic patients.
  
  
  OBJECTIVE
  To determine whether the relation between albuminuria and cardiovascular risk can be used to predict cardiovascular morbidity and mortality in hypertensive patients.
  
  
  METHODS
  Multicenter cohort study derived from a randomized, controlled trial.
  
  
  METHODS
  8206 patients with stage II or III hypertension randomly assigned to double-blind therapy with losartan or atenolol. Follow-up was 39 122 patient-years.
  
  
  METHODS
  Renal glomerular permeability evaluated by UACR.
  
  
  RESULTS
  In nondiabetic hypertensive patients with left ventricular hypertrophy, the risk for the composite cardiovascular end point increased continuously as albuminuria increased (P < 0.001 for trend). There was no specific threshold for increased risk. For every 10-fold increase in UACR, hazard ratios in nondiabetic patients increased as follows: composite end point, by 57% (95% CI, 40.6% to 75.0%); cardiovascular mortality, by 97.7% (CI, 66.5% to 235%); all-cause mortality, by 75.2% (CI, 54.0% to 99.4%); stroke, by 51.0% (CI, 28.8% to 76.9%); and myocardial infarction, by 45% (CI, 19.9% to 75.4%) (P < 0.001 for all comparisons). Values were similar in diabetic patients, although for myocardial infarction the trend was weaker and not significant.
  
  
  CONCLUSIONS
  Increased UACR resulted in increasing risk for cardiovascular morbidity and mortality among hypertensive patients with left ventricular hypertrophy. We found no thresholds or plateaus. Risk increases at much lower UACR values than has been reported among diabetic patients.
authors.affiliation: Department of Medicine, Glostrup University Hospital, Glostrup, Denmark. kristian@wachtell.net
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Michael H
authors.initials: MH
authors.lastname: Olsen
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: Lars H
authors.initials: LH
authors.lastname: Lindholm
authors.forename: Carl Erik
authors.initials: CE
authors.lastname: Mogensen
authors.forename: Björn
authors.initials: B
authors.lastname: Dahlöf
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Gareth
authors.initials: G
authors.lastname: Beevers
authors.forename: Ulf
authors.initials: U
authors.lastname: de Faire
authors.forename: Frej
authors.initials: F
authors.lastname: Fyhrquist
authors.forename: Stevo
authors.initials: S
authors.lastname: Julius
authors.forename: Sverre E
authors.initials: SE
authors.lastname: Kjeldsen
authors.forename: Krister
authors.initials: K
authors.lastname: Kristianson
authors.forename: Ole
authors.initials: O
authors.lastname: Lederballe-Pedersen
authors.forename: Markku S
authors.initials: MS
authors.lastname: Nieminen
authors.forename: Peter M
authors.initials: PM
authors.lastname: Okin
authors.forename: Per
authors.initials: P
authors.lastname: Omvik
authors.forename: Suzanne
authors.initials: S
authors.lastname: Oparil
authors.forename: Hans
authors.initials: H
authors.lastname: Wedel
authors.forename: Steven M
authors.initials: SM
authors.lastname: Snapinn
authors.forename: Peter
authors.initials: P
authors.lastname: Aurup
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death; D048909:Diabetes Complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000652:urine*; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000652:urine*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors