Risk Factors Of Microalbuminuria In Type 2 Diabetic Patients With Hypertension

Objective:To explore the risk factors of microalbuminuria(MAU)and analyze the correlation between MAU and systolic blood pressure(SBP)by comparing the baseline information of different proteinuria grades in type 2 diabetic patients with hypertension(HTN).Methods:1.This study was a cross-sectional study.From May 2019 to November 2021,a total of 385 patients with T2 DM and HTN and ≥50 years old who have participated in the “Blood Pressure Control Target in Diabetes(BPROAD)Trial” in the Endocrinolo-gy outpatient Department of Nanchang Third Hospital were examined,including 196 men and 189 women.According to the baseline urine albumin-to-creatinine ratio(UACR)of the subjects,the subjects were divided into three groups,the normal albuminuria group ACR1(UACR<30mg/g)(n=243 cases),mircoalbuminuria group ACR2(30mg/g≤ UACR<300mg/g)(n=114 cases)and the marcoalbuminuria group ACR3(UACR≥300mg/g)(n=28 cases).According to the baseline SBP of the research subjects,they were grouped from low to high,and divided into group A1,(SBP≤120mm Hg)(n=79 cases),group A2(120<SBP<130)mm Hg(n=75 cases);group A3(130≤SBP<140mm Hg)mm Hg(n=120 cases);group A4(SBP≥140mm Hg)(n=111 cases).2.Collect and record the baseline clinic information and baseline laboratory indexes of the selected subjects.All data were analyzed and processed using SPSS26.00 statistical software.The influencing factors of MAU were discussed through Logistic regression analysis.Results:1.Comparison of the general data and the laboratory indexes in normal albuminuria group,microalbuminuria group and macroalbuminuria group,indicated that the duration of diabetes in the microalbuminuria group was longer than that in the normal albuminuria group(P<0.05).Compared with the normal albuminuria group,the microalbuminuria group had significantly higher values of SBP,Hb A1 c,FPG and TG(P<0.05).Compared with the normal albuminuria group,the macroalbuminuria group had higher values of SBP,Hb A1 c,FPG,Scr and had lower values of e GFR,HDL-C,with statistical significant(P<0.05).Compared with the macroalbuminuria group,the microalbuminuria group had significantly higher values of e GFR(P<0.05).UACR,urinary microalbumin and 24-hour urinary protein increased with increasing grades of proteinuria(P<0.05).2.The correlation analysis of MAU with general data and laboratory indicators showed that MAU was positively correlated with the duration of diabetes,blood pressure subgroups,BMI,MAP,SBP,Hb A1 c,FPG,TG(P<0.05).3.The results of binary logistic regression analysis of the predictive factors of MAU showed that Scr increasing(OR=1.016,95%CI 1.005-1.028,P=0.004),elevated TG(OR=1.266,95%CI 1.046-1.532,P=0.015),SBP increasing(OR=1.027,95%CI 1.009-1.045,P=0.004),BMI increasing(OR=1.096,95%CI1.015-1.183,P=0.019),elevated Hb A1c(OR=1.544,95%CI 1.249-1.907,P<0.001),and concomitant DR(OR=1.722,95%CI 1.028-2.886,P=0.039)were independent risk factors for MAU.4.By analyzing the ROC curve,it is obtained that the area under the curve(AUC)of SBP,Hb A1 c,TG,and the regression equation for predicting the prevalence of MAU were 0.610,0.675,0.601,and 0.747,and the optimal cut-off point for SBP,Hb A1 c,TG and the regression equation were 132.5 mm Hg,7.25%,and 2.045mmol/L,0.41.5.The results of logical regression analysis showed that SBP,Hb A1 c,TG,and BMI were all risk factors of MAU.SBP<130mm Hg was defined as compliance,TG<1.70 mmol/L was defined as compliance,Hb A1c<7.0% was defined as blood glucose compliance,and BMI <24 kg/m2 was defined as compliance.According to the number of item compliance of SBP,Hb A1 c,TG,and BMI,it was divided into the4-item compliance group,the 3-item compliance group,the 2-item compliance group,the 1-item compliance group,and the 0-item compliance group.The result showed that compared with the 0-item compliance group,the 2-item compliance group,the 3-item compliance group,and the 4-item compliance group had a lower prevalence of MAU.6.When the compliance status was used as a continuous variable,the risk of MAU disease decreases by 40% for each additional item compliance(OR=0.600,95% CI 0.461-0.781,P<0.001).When compliance status was used as a classification variable,compared with patients with 0-item compliance group,the risk of MAU disease in patients with 2-item compliance group,3-item compliance group,and 4-item compliance group decreased by 63%,79%,and 90% respectively(OR were0.374,0.208,and 0.101 respectively,P<0.05).7.The distribution of blood pressure groups in proteinuria subgroups showed that: Subjects with lower proteinuria grades tend to have better blood pressure control(SBP≤120mm Hg),P<0.001.The result of Spearman rank correlation analysis showed P<0.001,it can be considered that there is a statistical association between the proteinuria classification and the blood pressure grouping,the degree of correlation is0.185.8.The results of logistic regression analysis of SBP as a categorical variable with MAU showed that,compared with patients with SBP≥140mm Hg,patients with SBP≤120 mm Hg had a significantly reduced risk of MAU(OR=0.336,95%CI 0.159-0.709,P=0.004).There was no significant difference in the risk of MAU between patients with SBP ≥ 140 mm Hg and those with 120<SBP<130 mm Hg or130≤SBP<140 mm Hg(OR=0.490,95%CI 0.235-1.022,P=0.057;OR=0.658,95%CI 0.352-1.231,P=0.190).Conclusions:In middle-aged and elderly patients with type 2 diabetes and hypertension,the highlighted risk factors for the presence of microalbuminuria were SBP、Hb A1c、TG、BMI、DR、Scr.In clinical practice,multiple items among SBP,Hb A1 c,TG,and BMI should be controlled to meet the standards.Controlling SBP≤120mm Hg could diminish the prevalence of MAU.