2003 Volume 30 Issue 2 Pages 209-216
In this study, we examined the relationship of 24-hour ambulatory blood pressure (24-hABP) and pulse pressure to urinary total protein mg/g Creatinine ratio (TPmg/gCRE) and urinary albumin mg/g Creatinine ratio (ALBmg/gCRE) . We examined 222 community-based elderly Japanese people aged 71.0±10.8 years, who participated in a medical examination given in the Tsukuba district, and classified these patients into two groups according to the presence or absence of antihypertensive medications.
We carried out X2 test on each of the two groups because we examined whether hypertension was related to urinary albumin excretion. Under all conditions, we recognized significant differences. Therefore, we categorized them as having normoalbuminuria (<30 mg/gCRE), and abnormal albuminuria (≥30 mg/gCRE), based on ALBmg/gCRE. In patients with antihypertensive medications, average systolic blood pressure (SBP) and pulse pressure under all 24-hABP measuring conditions (24-hour, daytime, night time and casual time) was significantly higher in patients with abnormal albuminuria than in patients with normoalbuminuria. However, in patients without antihypertensive medications, average 24-hour, night time and casual time SBP was significantly higher in patients with abnormal albuminuria than in patients with normoalbuminuria, pulse pressure did not differ significantly between the two groups under any condition.
Moreover, univariate regression analysis showed a close relationship between 24-hABP and TPmg/gCRE and ALBmg/gCRE. In patients without antihypertensive medications, both TPmg/gCRE and ALBmg/gCRE correlated significantly with SBP and pulse pressure under all 24-hABP mesuring conditions. However in patients with antihypertensive medications, ALBmg/gCRE correlated significantly with SBP and pulse pressure under all 24-hABP mesuring conditions, TPmg/gCRE correlated significantly only with nighttime pulse pressure.
Therefore, we recognized that in elderly Japanese people, SBP and pulse pressure played significant roles as determining factors of albuminuria.
We also studied the usefulness of antihypertensive medications by examining the effect of antihypertensive medications on TPmg/gCRE and ALBmg/gCRE and subcategorized these patients as having hypertension (24-hour SBP≥135 mmHg or 24-hour DBP≥85 mmHg), or normotension in each group according to the presence or absence of antihypertensive medications. Average TPmg/gCRE and ALBmg/gCRE were significantly lower in normotensive patients with antihypertensive medications than in hypertensive patients without antihypertensive medications.
Thus, it was suggested that by maintaining the blood pressure below the standardized level with antihypertensive medications, renal disorder with hypertension could be avoided. Therefore, we thought that the antihypertensive medications were significantly useful in elderly Japanese people with hypertension, and that it was possible to recognize renal disorder as a complication of hypertension in the early stage by regularly measuring TPmg/gCRE and ALBmg/gCRE.