title: Cumulative systolic BP and changes in urine albumin-to-creatinine ratios in nondiabetic participants of the multi-ethnic study of atherosclerosis.
abstract: OBJECTIVE
  Cumulative exposure to elevated systolic BP (cumSBP) may affect progression of urine albumin excretion in the absence of diabetes. The objective of this study was to examine the association between cumSBP exposure and progression of spot urine albumin-to-creatinine ratio (UACR) in a multi-ethnic cohort of adults without diabetes.
  
  
  METHODS
  The analysis included 3789 participants without severely increased urine albumin excretion or diabetes in the Multi-Ethnic Study of Atherosclerosis, a cohort of 6814 adults aged 45-84 years. UACR was measured at baseline and approximately 1.6, 3.1, and 9.4 years after the baseline examination. cumSBP was calculated as the summed average systolic BP (SBP; mmHg) between two consecutive examinations multiplied by the time between the two examinations (mmHg × year) and categorized as ≤ 1128 (SBP<120 mmHg), 1129-1222 (SBP ≥ 120-129 mmHg), 1223-1316 (SBP ≥ 130-130 mmHg), and > 1316 (SBP ≥ 140 mmHg). Baseline UACR was categori zed as normal, mildly increased, or moderately increased, and definite progression of UACR was defined as a persistently higher UACR category at subsequent examinations. No UACR progression was defined as remaining in the same UACR category across all examinations or regressing.
  
  
  RESULTS
  In fully adjusted models, compared with cumSBP ≤ 1128 mmHg, cumSBP 1223-1316 and >1316 mmHg was associated with a 85% and 130% significantly higher odds of definite UACR progression (95% confidence interval, 24% to 178% and 56% to 243%, respectively) versus no UACR progression. Every 100-mmHg higher level of cumSBP was associated with a 1.23-fold higher odds of definite UACR progression (95% confidence interval, 1.13 to 1.34) versus no UACR progression.
  
  
  CONCLUSIONS
  Exposure to higher cumSBP was associated with increased UACR progression among adults without diabetes.
authors.affiliation: Department of Public Health Sciences and.
authors.forename: Paul
authors.initials: P
authors.lastname: Zemaitis
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Department of Nutrition, University of Oslo, Oslo, Norway;
authors.forename: David R
authors.initials: DR
authors.lastname: Jacobs
authors.affiliation: Department of Pathology, University of Vermont, Colchester, Vermont; and.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Department of Public Health Sciences and.
authors.forename: Ramon
authors.initials: R
authors.lastname: Durazo-Arvizu
authors.affiliation: Department of Public Health Sciences and.
authors.forename: David
authors.initials: D
authors.lastname: Shoham
authors.affiliation: Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Walter
authors.initials: W
authors.lastname: Palmas
authors.affiliation: Department of Public Health Sciences and.
authors.forename: Richard
authors.initials: R
authors.lastname: Cooper
authors.affiliation: Department of Public Health Sciences and Department of Medicine, Division of Nephrology and Hypertension, Loyola University Health Sciences Center, Maywood, Illinois; hkramer@luc.edu.
authors.forename: Holly
authors.initials: H
authors.lastname: Kramer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000503:physiopathology* / Q000652:urine*; D050197:Atherosclerosis / Q000652:urine; D015415:Biomarkers / Q000652:urine; D001794:Blood Pressure; D003404:Creatinine / Q000652:urine*; D003920:Diabetes Mellitus / Q000652:urine; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013599:Systole
chemical_list: D015415:Biomarkers; D003404:Creatinine
keywords: albuminuria; blood pressure; chronic kidney disease