title: Urinary albumin excretion and glomerular filtration rate across the spectrum of glucose abnormalities in essential hypertension.
abstract: The objective of this study was to assess the relationship between urinary albumin excretion (UAE) and GF across the spectrum of the glucose metabolism abnormalities in a large population of patients with hypertension. The Microaluminuria en Pacientes con Glucemia Basal Alterada (MAGAL) is a multicenter, cross-sectional study that was carried out by 1723 primary care physicians. A total of 6227 patients with essential hypertension (in three groups: [1] normal fasting glucose <100 mg/dl, [2] impaired fasting glucose > or =100 to 126 mg/dl, and [3] type 2 diabetes) were analyzed in this substudy. GFR was estimated by using the Modification of Diet in Renal Disease (MDRD) abbreviated equation. A single first-morning urine albumin/creatinine ratio was measured using Bayer reagent strip Microalbustix, a semiquantitative method. Abnormal UAE was defined as an albumin/creatinine ratio > or =3.4 mg/mmol (equivalent to > or =30 mg/g). The prevalence of abnormal UAE, > or =3.4 mg/mmol, increased across the spectrum of glucose abnormalities: 39.7, 46.2, 48.6, and 65.6% for normoglycemic, low-range, and high-range impaired fasting glucose and diabetes, respectively. UAE was positively related to SBP (P = 0.003) and inversely to GFR (P < 0.001). Renal insufficiency (GFR <60 ml/min per 1.73 m2) was present in 21.8% of the patients, more frequently older patients, women, and those with diabetes. The factors that were related to renal insufficiency were UAE > or =3.4 mg/mmol (odds ratio 1.86; 95% confidence interval 1.60 to 2.17) and diabetes (odds ratio 1.62; 95% confidence interval 1.29 to 2.04). There is a close relationship between abnormal UAE and renal insufficiency in essential hypertension. This is more marked in patients with diabetes and moderate in patients with high-range impaired fasting glucose.
authors.affiliation: Hypertension Clinic, Internal Medicine Service, Hospital Clinico, University of Valencia, 46010 Valencia, Spain. josep.redon@uv.es
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
authors.forename: Francisco
authors.initials: F
authors.lastname: Morales-Olivas
authors.forename: Alberto
authors.initials: A
authors.lastname: Galgo
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Brito
authors.forename: Javier
authors.initials: J
authors.lastname: Mediavilla
authors.forename: Rafael
authors.initials: R
authors.lastname: Marín
authors.forename: Pilar
authors.initials: P
authors.lastname: Rodríguez
authors.forename: Salvador
authors.initials: S
authors.lastname: Tranche
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Lozano
authors.forename: Claudia
authors.initials: C
authors.lastname: Filozof
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D006973:Hypertension / Q000150:complications / Q000378:metabolism* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology
chemical_list: D005947:Glucose