Research Article: The Effects of Urinary Albumin and Hypertension on All-Cause and Cardiovascular Disease Mortality in Korea

Date Published: August 02, 2017

Publisher: Oxford University Press

Author(s): Mi Hae Seo, Jong-Young Lee, Seungho Ryu, Yu Sam Won, Ki Chul Sung.


Urinary albumin levels and hypertension (HTN) are independently associated with an increased risk of all-cause mortality. The effect of albuminuria on mortality in the absence or presence of HTN is uncertain. This study aimed to evaluate the effect of albuminuria and HTN on all-cause and cardiovascular disease (CVD) mortality.

Mortality outcomes for 32,653 Koreans enrolled in a health screening including measurements of the urinary albumin/creatinine ratio (UACR) at baseline and median follow-up of 5.13 years. Receiver operating characteristic curve analyses were performed in UACR and the cut-point was 5.42 mg/g. The participants for UACR at the cut-point of 5.42 μg/mg were categorized into UACR < 5.42 or UACR ≥ 5.42. HTN status was categorized as No HTN or HTN (defined as the absence or presence HTN). The median (interquartile) baseline UACRs were higher in those who died than in survivors. Subjects with a UACR ≥ 5.42 mg/g without or with HTN showed a similar increased risk for all-cause mortality and CVD mortality, even after adjusting for known CVD risk factors compared to those with no HTN/UACR < 5.42 (reference), (all-cause mortality; hazard ratio [HR] 1.48; 95% confidence interval [CI] 1.02–2.15: HR 1.47; 95% CI 0.94–2.32, respectively), (CVD mortality; HR 5.75; 95% CI 1.54–21.47: HR 5.87; 95% CI 1.36–25.29) The presence of urinary albumin and HTN is a significant determinant of CVD and death. Urinary albumin might be more attributable to CVD and all-cause mortality than HTN.

Partial Text

There were 249 deaths during the follow-up period (Table 1). Table 1 describes the baseline clinical characteristics analyzed according to the vital status at follow-up. Subjects who died were older, and a higher proportion had a history of HTN at baseline. Other conventional cardiovascular risk factors including glucose, triglycerides, and blood pressure, were also higher, and the HDL-C and proportion of those performing regular exercise was lower in subjects who died by the end of the follow-up period. At baseline, mean and median UACR were higher in the group who died during follow-up compared to survivors.

We describe the effects of HTN and urinary albumin levels on all-cause and cardiovascular mortality in a large number of Koreans participating in a health screening program with a median follow-up of 5.13 years.

Supplementary data are available at American Journal of Hypertension online.

The authors declared no conflicts of interest.




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