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European Heart Journal Advance Access originally published online on September 7, 2007
European Heart Journal 2007 28(21):2690; doi:10.1093/eurheartj/ehm389
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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? reply

Erik Ingelsson

Department of Public Health and Caring Sciences/ Geriatrics
Uppsala University
Uppsala Science Park
751 85 Uppsala
Sweden

Johan Ärnlöv

Department of Public Health and Caring Sciences/ Geriatrics
Uppsala University
Uppsala Science Park
751 85 Uppsala
Sweden

Tel: +46 18 6117963 Fax: +46 18 6117976 E-mail address: johan.arnlov{at}pubcare.uu.se

We are grateful to Dr Parmar for raising this important issue. Dr Parmar appears to be under the impression that our study sample consisted of elderly men with hypertension. It is important to clarify that a wide range of blood pressure levels were represented in the participants without anti-hypertensive treatment in our community-based sample of elderly men (n = 726).1 In these participants, the mean systolic blood pressure was 144 mmHg (range 102–207 mmHg), the mean diastolic blood pressure was 82 mmHg (range 57–111 mmHg), and 61% were defined as hypertensives (systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg).

More importantly, Dr Parmar hypothesizes that higher urinary albumin excretion rate (UAER) may merely be a surrogate marker for poor blood pressure control rather than an independent risk factor for heart failure incidence. That hypothesis, however, is not supported by our data.

In all multivariable models, the association of UAER to heart failure incidence was independent of hypertension prevalence at baseline.1 Nonetheless, it is possible that some of the predictive information of the blood pressure variables could be lost due to the categorization of participants into hypertensives/non-hypertensives. In order to investigate whether the actual blood pressure levels rather than the hypertension diagnosis could explain the association between UAER and heart failure incidence, we replaced the hypertension variable in our multivariable models with systolic blood pressure and diastolic blood pressure (modelled as continuous variables). As seen in Table 1, the results remained essentially identical. Thus, in contrast to Dr Parmars' hypothesis, the association between UAER and heart failure incidence in our study does not appear mediated by baseline blood pressure levels.


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  		Table 1 The association of urinary albumin excretion rate to heart failure incidence in participants without anti-hypertensive medication (n = 726)

 

Reference

  1. Ingelsson E, Sundström J, Lind L, Risérus U, Larsson A, Basu S, Ärnlöv 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]

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