Hypertension is more likely to develop in women with high but normal albumin/creatinine ratios (ACRs) than in women with lower ACRs, according to a new analysis of data from the Nurses’ Health Studies (NHS).


“The findings of this study, in conjunction with the findings of numerous others, including the Framingham Heart Study, HOPE, and LIFE, suggest that it may be time to re-evaluate our current concept of ‘normal’ albumin excretion,” the authors conclude in the Journal of the American Society of Nephrology (online ahead of print). Previous research has tied high-normal ACRs to higher risks of cardiovascular events.

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John Forman, MD, led a team at Brigham and Women’s Hospital in Boston that 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 below 25 mg/g, and none had diabetes at baseline.


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


The association held up when the investigators adjusted for such risk factors as BMI, baseline BP, smoking, estimated glomerular filtration rate, physical activity, and family history of hypertension.


“Higher levels of urine albumin excretion may reflect systemic endothelial dysfunction, which in turn may be a precursor to hypertension,” the authors wrote.