Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun;46(6):622-631.
doi: 10.1002/clc.24012. Epub 2023 Apr 5.

Association between urinary albumin-to-creatinine ratio within normal range and hypertension among adults in the United States: Data from the NHANES 2009-2018

Li Ming  1 , Duan Wang  2 , Yong Zhu  3
Affiliations

Association between urinary albumin-to-creatinine ratio within normal range and hypertension among adults in the United States: Data from the NHANES 2009-2018

Li Ming et al. Clin Cardiol. 2023 Jun.

Abstract

Background: Recently it was suggested that urine albumin-to-creatinine ratio (uACR), even within the normal range, can be associated with hypertension, but only a few studies have examined. Therefore, this study aimed to determine the association between normal range uACR and the prevalence of hypertension.

Methods: The research used data from the 2009 to 2018 National Health and Nutrition Examination Survey, which included 14,919 participants. We defined the uACR as the amount of albumin (mg/dL) divided by creatinine (g/dL) in randomly voided urine. Hypertension was defined as mean systolic blood pressure ≥130 mmHg, or diastolic ≥80 mmHg, or were taking hypertension medication or were informed of a hypertension diagnosis by a physician/health professional.

Results: In multivariable-adjusted models, per 5 mg/g uACR increment, the hypertension prevalence increased 1.31-fold (OR, 1.31; 95% CI 1.23-1.40), the odds [95% confidence interval (CI)] for hypertension prevalence were 2.25 (1.86-2.72) for those in the highest quartile compared to those in the lowest quartile. The nonlinear relationship between hypertension prevalence and uACR was found by visually assessing images (p for nonlinearity<.001). In addition, in the subgroup analysis stratified by body mass index, the lower the BMI, the stronger the association between uACR and hypertension prevalence.

Conclusions: Even within the normal range, subtly elevated uACR was associated with an increased prevalence of hypertension in the USA general population, and this association may be enhanced in individuals with low BMI. Further research is needed to assess the clinical applicability of these findings.

Keywords: NHANES; albuminuria; hypertension; urinary albumin-to-creatinine ratio.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the sample selection from National Health and Nutrition Examination Survey 2009–2018.
Figure 2
Figure 2
Association between urine albumin‐to‐creatinine ratio and the prevalence of hypertension. The solid line and dashed line represent the estimated values and their corresponding 95% confidence interval.
Figure 3
Figure 3
Stratified analyses by potential modifiers of the association between urine albumin‐to‐creatinine ratio and the prevalence of hypertension.
See this image and copyright information in PMC

References

    1. Lamprea‐Montealegre JA, Shlipak MG, Estrella MM. Chronic kidney disease detection, staging and treatment in cardiovascular disease prevention. Heart. 2021;107:1282‐1288. - PubMed
    1. National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention . Chronic Kidney Disease (CKD) Surveillance System. https://www.cdc.gov/chronicdisease/data/surveillance.htm
    1. Johansen KL, Chertow GM, Gilbertson DT, et al. US renal data system 2021 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2022;79:A8‐A12. - PMC - PubMed
    1. GBD Chronic Kidney Disease Collaboration . Global, regional, and national burden of chronic kidney disease 1990‐2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2020;395:709‐733. - PMC - PubMed
    1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351:1296‐1305. - PubMed