"Normal" ACR warrants a second look

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Women with high but normal albumin/creatinine ratios (ACRs) are much more likely to develop hypertension than women with lower ACRs, according to a new analysis of data from the Nurses' Health Studies (NHS).

Previous research has tied high-normal ACRs to higher risks of cardiovascular events. “The findings of this study, in conjunction with the findings of numerous others, suggest that it may be time to re-evaluate our current concept of ‘normal' albumin excretion,” the authors conclude.

John Forman, MD, and colleagues at Brigham and Women's Hospital in Boston tracked the onset of hypertension in 1,065 postmenopausal women from the NHS I and 1,114 premenopausal women from NHS II. All had an ACR <25 mg/g, and none had diabetes at baseline.

Among the older women (median age 65 years), those whose ACR ranked in the highest quartile (4.34-24.17 mg/g) were 76% more likely to develop hypertension within four years than those in the lowest quartile. The trend was less severe among the younger group (median age 44 years). Those in the top quartile (3.68-23.84 mg/g) were 35% more likely to become hypertensive within eight years than those at the bottom.

The association held up when such risk factors as BMI, baseline BP, smoking, estimated glomerular filtration rate, physical activity, and family history of hypertension were taken into consideration. “Higher levels of urine albumin excretion may reflect systemic endothelial dysfunction, which in turn may be a precursor to hypertension,” the authors suggest.

Their study, which appeared online ahead of print, is scheduled for publication in the Journal of the American Society of Nephrology.
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