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European Heart Journal Advance Access originally published online on September 7, 2007
European Heart Journal 2007 28(21):2689-2690; doi:10.1093/eurheartj/ehm388
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Albuminuria and heart failure: is it an albuminuria or the hypertension?

Malvinder S. Parmar

Associate Professor Clinical Sciences Division
Northern Ontario Medical School Lakehead and Laurentian Universities, and Timmins and District Hospital 640 Ross Ave. East Suite E Timmins
Ontario
Canada P4 N 8P2

Tel: +1 705 268 8066 Fax: +1 705 268 8066 E-mail address: atbeat{at}ntl.sympatico.ca

Ingelsson et al.1 elegantly emphasized albuminuria as a risk factor for heart failure in elderly hypertensive men and present thought-provoking speculative mechanisms. However, the association between albuminuria and heart failure was seen in untreated hypertensive men compared to treated hypertension, suggesting that treated hypertensive men had advanced hypertension and thereby hypertensive heart disease with natural progression to heart failure, and therapy likely attenuated both the progression of albuminuria and heart failure. In the 40 untreated hypertensive men who developed heart failure during follow-up, the risk of heart failure was higher in those with higher degree of albumin excretion rate (AER). Authors presented analysis of various sub-groups but I could not find a similar analysis in relation to the degree of hypertension. Urinary AER has been shown to be positively correlated with the degree of blood pressure.2–4 It is possible that men with higher elevations of blood pressure, in this untreated group had higher degree of AER. Hypertension per say is an important cause of heart failure. In this subgroup of untreated hypertensives, men with higher elevations of BP were at increased risk for both AER and heart failure. As the authors state that it is unlikely that a very small concentration of albumin in urine in itself is the cause of increased risk for heart failure. I agree with the conclusion that low-grade albuminuria is a marker for subclinical cardiovascular damage but cannot affirm from this study that it predisposes to future heart failure.

References

  1. Ingelsson E, Sundström J, Lind L, Risérus U, Larsson A, Basu S, Arnlöv J. Low-grade albuminuria and the incidence of heart failure in a community-based cohort of elderly men. Eur Heart J (2007) 28:1739–1745.[Abstract/Free Full Text]
  2. Redon J, Liao Y, Lozano JV, Miralles A, Pascual JM, Cooper RS. Ambulatory blood pressure and microalbuminuria in essential hypertension: role of circadian variability. J Hypertens (1994) 8:947–953.[CrossRef]
  3. Hörner D, Fliser D, Klimm HP, Ritz E. Albuminuria in normotensive and hypertensive individuals attending offices of general practitioners. J Hypertens (1996) 5:655–660.
  4. Knight EL, Kramer HM, Curhan GC. High-normal blood pressure microalbuminuria. Am J Kidney Dis (2003) 3:588–595.

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This Article
Right arrow FREE Full Text (PDF) Freely available
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28/21/2689-a    most recent
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