Relationship Between Central Aortic Pressure And Urinary Albumin To Creatinine Ratio In Patients With Essential Hypertension

Objectives:The present study aimed to investigate the relationship between central aortic pressure（CAP）and urinary albumin to creatinine ratio（UACR）in patients with essential hypertension（EH）.Methods:A total of 927 subjects（578 male patients and 349 female patients,with an average age of 57.07±11.44 years）who were treated from outpatients and inpatients in general medicine and geriatric departments from the First Affiliated Hospital of Fujian Medical University were retrospectively analyzed between January 2016 and March 2019.Central systolic blood pressure（cSBP）and central diastolic blood pressure（cDBP）were detected by an automatic arteriosclerosis and cardiac function detection system（Complior Analyse,France）.A first-voided spot urine sample was collected in the early morning for assessing UACR=urinary albumin（mg）/urine creatinine（g）.Firstly,all participants were divided into normal albuminuria group（UACR<30mg/g,804 cases）and abnormal albuminuria group（UACR≥30mg/g,123 cases）according to the level of UACR.In addition,the subjects with normal albuminuria had a further stratification based on the median of UACR in its group,named low-level of normal albuminuria group（UACR<6.04 mg/g,402 cases）and high-level of normal albuminuria group（UACR≥6.04,but<30mg/g,402 cases）.Furthermore,all participants were divided into four groups based on the presence of hypertension（HT）and diabetes（DM）:control group（n=269）,DM group（n=76）,HT group（n=437）and HT+DM group（n=145）.The differences of age,gender,BMI,central aortic pressure,the duration of hypertension,the duration of diabetes,serum creatinine,UACR,eGFR,the proportion of using CCB（calcium channel blockers）were compared among groups.A multivariate analysis of variance was used to investigate the association of hypertension and diabetes with UACR.Spearman correlation analysis was used to analyze the correlative factors of UACR.Multivariate linear regression analysis was used to examine the association of UACR with clinical indicators including cSBP.Logistic analysis was performed to distinguish the related factors of UACR≥30mg/g.Results:1.For the different UACR levels,a gradual increase in cSBP,cDBP,the proportion of hypertension,the proportion of diabetes,the proportion of using CCB,the duration of hypertension,was observed from low-level of normal albuminuria group,high-level of normal albuminuria group to abnormal albuminuria group（P<0.05）.Compared with the control group,the levels of UACR,cSBP,cDBP,body mass index,age,fasting blood glucose were higher,and the level of eGFR were lower in both HT group and HT+DM group（P<0.05）.The levels of UACR,cSBP,cDBP,body mass index,age,serum creatinine were higher,and the levels of total cholesterol,low density lipoprotein cholesterol,eGFR and glycosylated hemoglobin were lower in the HT+DM group than those in DM group（P<0.05）.2.Multivariate analysis of variance showed that P_interaction=0.176,P_hypertension<0.001,Pdiabetes=0.185.3.In all participants,spearman correlation analysis showed that cSBP,cDBP,age,body mass index,the duration of hypertension,the duration of diabetes,heart rate,fasting blood glucose,glycosylated hemoglobin,triglyceride,the use of ACEI/ARB,the use of CCB were positively correlated with UACR[r_spearman（r_s）)=0.313,0.162,0.087,0.068,0.252,0.139,0.121,0.198,0.149,0.178,0.113,0.075,P<0.05].Male gender,serum creatinine and uric acid were negatively correlated with UACR（r_s=-0.195,-0.182,-0.076,P<0.05）.4.In all participants,multiple linear regression analysis found that cSBP,the duration of hypertension,the duration of diabetes,the use of CCB were associated with UACR independently in general population（β=0.191,0.078,0.065,0.086,P<0.05）.5.Subgroup analysis was based on presence of HT and DM,levels of urinary albumin,gender and age.In both HT group and HT+DM group,cSBP was associated with UACR independently（β=0.226、0.180,P<0.05）.Fasting blood glucose was associated with UACR independently in DM group（β=0.336,P<0.05）.It was found that cSBP was the related factors of UACR in both high-level of normal albuminuria group and the abnormal albuminuria group（β=0.139、0.182,P<0.05）.cSBP was found to be independent related factors of UACR in the male,female,age≥45 but<70 years old group（P<0.05）.6.Subgroup analysis based on the duration of HT（10、15years）,gender,age（65years old）,the use of CCB and ACEI/ARB in patients with essential hypertension found that cSBP was associated with UACR independently in all subgroups.7.The logistic regression analysis showed that:cSBP（OR:1.039,95%CI:1.026～1.052,P<0.05）、the duration of HT（OR:1.034,95%CI:1.005～1.065,P<0.05）、heart rate（OR:1.027,95%CI:1.010～1.044,P<0.05）、the use of CCB（OR:0.444,95%CI:0.284～0.696,P<0.05）were associated with the appearance of UACR≥30mg/g.Conclusion:Central systolic blood pressure was positively associated with UACR in essential hypertensives with/without diabetes.The duration of HT and DM were associated with UACR,the longer course had better association.