title: Proteinuria Is an Independent Risk Factor for First Incident Stroke in Adults Under Treatment for Hypertension in China.
abstract: BACKGROUND
  Conflicting evidence exists regarding whether reduced estimated glomerular filtration rate (eGFR) and proteinuria are independent risk factors for stroke and its subtypes in hypertensive patients. This study investigated the association of these renal measures with first incident stroke in adults under treatment for hypertension in China.
  
  
  RESULTS
  The study included 19 599 adults aged 45 to 75 years who participated in the China Stroke Primary Prevention Trial. Baseline eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Proteinuria was assessed by qualitative dipstick urinalysis and in a subset by the quantitative albumin-creatinine ratio method. Cox regression analysis was used to examine the effects of eGFR and proteinuria on the risk of first incident stroke. During a median of 4.5 years of follow-up, a total of 585 first strokes (472 ischemic strokes) were identified. Compared to participants without proteinuria, participants with proteinuria (trace or more by dipstick) had a 35% increased risk of first stroke: the adjusted hazard ratio (HR) (95% CI) was 1.35 (1.09-1.66, P=0.005). The results were robust in subgroup analyses. In a subset with data on proteinuria measured by quantitative albumin-creatinine ratio, a similar association was found. In both independent and combined analyses with proteinuria, eGFR was not significantly associated with stroke.
  
  
  CONCLUSIONS
  In adults under treatment for hypertension in China, baseline proteinuria measured by dipstick or quantitative albumin-creatinine ratio, but not reduced eGFR, was found to be an independent risk factor for first incident stroke and ischemic stroke.
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).
authors.forename: Chunyan
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (X.W.).
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Neurology, First People's Hospital, Lianyungang, China (M.H.).
authors.forename: Mingli
authors.initials: M
authors.lastname: He
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).
authors.forename: Xianhui
authors.initials: X
authors.lastname: Qin
authors.affiliation: Institute for Biomedicine, Anhui Medical University, Hefei, China (G.T.).
authors.forename: Genfu
authors.initials: G
authors.lastname: Tang
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).
authors.forename: Yu
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Cardiology Department, Peking University First Hospital, Beijing, China (Y.H.).
authors.forename: Yong
authors.initials: Y
authors.lastname: Huo
authors.affiliation: Department of Neurology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China (Y.C.).
authors.forename: Yefeng
authors.initials: Y
authors.lastname: Cai
authors.affiliation: Department of Neurology, First Affiliated Hospital of Anhui Medical University, Hefei, China (J.F.).
authors.forename: Jia
authors.initials: J
authors.lastname: Fu
authors.affiliation: Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China (G.Z.).
authors.forename: Gang
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China (Q.D.).
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.) AUSA Research Institute, Shenzhen AUSA Pharmed Co Ltd, Shenzhen, China (X.X.).
authors.forename: Xiping
authors.initials: X
authors.lastname: Xu
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).
authors.forename: Binyan
authors.initials: B
authors.lastname: Wang
authors.affiliation: National Clinical Research Study Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Renal Division, Nanfang Hospital, Southern Medical University, Guangzhou, China (C.Z., X.Q., X.X., Y.W., X.X., B.W., F.F.H.).
authors.forename: Fan Fan
authors.initials: FF
authors.lastname: Hou
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000959:Antihypertensive Agents
keywords: Chinese hypertensive adults; albumin–creatinine ratio; estimated glomerular filtration rate; first incident stroke; proteinuria