Microalbuminuria and cardiovascular risk assessment in primary hypertension: should threshold levels be revised?
Abstract
BACKGROUND: Urinary albumin excretion and left ventricular mass are related to each other and to the risk of cardiovascular events in patients with primary hypertension. We aimed to identify a lower threshold for albuminuria that might improve detection of patients with left ventricular hypertrophy (LVH) and cost-effectiveness in cardiovascular risk assessment. METHODS: Albuminuria and left ventricular mass index were assessed in 448 untreated, nondiabetic patients with primary hypertension. The impact that lower albuminuria cut-off levels might have on detecting LVH was evaluated with regard to test cost and sensitivity. This was done by a diagnostic algorithm consisting of albuminuria evaluation followed by echocardiography in the presence of normoalbuminuria. RESULTS: The area under the ROC curve of albuminuria in predicting LVH was 0.73. Using a lower albumin to creatinine ratio threshold than what is recommended by the guidelines (ie, 11.5 mg/g), the sensitivity and specificity of albuminuria in identifying patients with LVH was 39% and 92%, respectively, which translated to positive and negative predictive values of 76% and 69%, respectively. When considering only patients without electrocardiographically detected LVH, routine screening for albuminuria, followed by echocardiography in the presence of albuminuria
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Cardiovascular risk may extend below the lower limit of 30 mg/day of albuminuria.
“Moreover, cardiovascular risk may extend below the lower limit of 30 mg/day (463-465)”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [465]
Recent data suggest that cardiovascular risk extends below the lower limit of 20 mg/min, reinforcing that albuminuria is a continuous variable for cardiovascular risk.
“Recent data, however, suggest that risk extends below the lower limit of 20 mg/min (328-330), reinforcing the notion that this factor is a continuous variable for cardiovascular risk (331)(332)(333).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [330]
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- Authors
- RATTO, E., LEONCINI, G., VIAZZI, F., VACCARO, V, PARODI, A., FALQUI, V, BEZANTE, G., TOMOLILLO, C., DEFERRARI, G., & PONTREMOLI, R.
- Affiliations
- Ospedale Policlinico San Martino (IT)
- Corresponding author
- PONTREMOLI, R
- Venue
- American Journal of Hypertension
- Publisher
- Oxford University Press (OUP)
- Published
- 2006-07
- Volume
- 19
- Issue
- 7
- Pages
- 728-734
- ISSN
- 0895-7061 (ISSN-L)
- OpenAlex
- W2089379699
- Semantic Scholar
- 01354bdf494819b9f6091c147d90bcb248a41ae5
- Cited by
- 17
- References
- 24
- Citations by year
- 2023: 2 · 2020: 2 · 2017: 1 · 2015: 1 · 2013: 1 · 2012: 1
- FWCI
- 0.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Keywords
- microalbuminuria, essential hypertension, left ventricular hypertrophy, albumin-creatinine ratio, diagnostic thresholds, cardiovascular risk assessment, echocardiography, cost-effectiveness of screening, sensitivity and specificity
- MeSH terms
- Adult, Aged, Albuminuria, Blood Pressure, Cardiovascular System, Echocardiography, Female, Humans, Hypertension, Male, Middle Aged, Sensitivity and Specificity, Hypertrophy, Left Ventricular, Risk Assessment
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