The urinary albumin and hypertension (HTN) is independently associated with an increased risk of all-cause mortality. The effect of albuminuria with absence or presence HTN uncertain in mortality. This study aimed to evaluated the effect of urinary albumin and hypertension on all-cause and cardiovascular disease (CVD) mortality.Design and Method:
Mortality outcomes for 39460 Koreans enrolled in a health screening with measurements of Urine albumin creatinine ratio (UACR) at baseline and median follow-up of 5.13 years were analyzed between 2002 and 2012. UACR is a reliable index of urinary albumin excretion. UACR results were ranked and participants were also categorized into UACR < 75 or UACR ≥ 75 if they were respectively above or below the 75th percentile. Hypertension status divided into No HTN and HTN (defined: absence and presence HTN). Hazard ratios (HRs) and 95% CIs for CVD and all-cause mortality at follow-up were estimated using Cox proportional hazards models.Results:
During the follow-up, 404 deaths were recorded. The median (interquartile) baseline UACR were higher in Dead than in Alive [6.59 (4.09–13.58) vs. 4.95 (3.44–8.03), P < 0.001]. Subjects with UACR ≥ 75 with absence or presence HTN showed a similar increased risk for all-cause mortality, even after adjustment for known CVD risk factors compared with No HTN/UACR < 75(reference), (HR, 1.47; 95% confidence interval [CI], 1.02–2.13: HR, 1.46; 95 %CI,1.03–2.06, respectively). The Hazard ratio of CVD mortality for HTN/ACR<75 and No HTN/ACR ≥ 75 were 1.56 (95% CI, 0.60–4.07) and 2.48 (95% CI, 0.90–6.83), respectively. When subjects with HTN had an UACR ≥ 75, CVD mortality was significantly increased risk compared with no HTN and UACR < 75 (HR, 3.09; 95% CI, 1.25–7.62).Conclusions:
Urinary albumin and HTN is a significant determinant of CVD and death. Urinary albumin is more attributable to CVD and all-cause mortality than HTN.