Does microalbuminuria predict cardiovascular mortality in treated hypertensive men?

The purpose of the present analysis was to examine the predictive power of microalbuminuria for total and cardiovascular mortality in a prospective study (mean follow-up 6.3 years) of treated hypertensive men, aged 50-72 years, with (n=94) and without (n=345) maturity onset-diabetes mellitus. Thirty-three (35.1%) of the hypertensive patients with diabetes mellitus died during the follow-up period compared to 57 (16.5%) in the hypertensive group without diabetes mellitus (p<0.0002). In those with diabetes mellitus and hypertension, a log-rank test revealed a lower cardiovascular mortality in the normoalbuminuric group (n=45) compared to both the microalbuminuric (n=36, P=0.035) and the macroalbuminuric group (n=13, P=0.002). Among these patients, the logarithm of urinary albumin excretion was a predictor of both total (p=0.001) and cardiovascular (p=0.001) mortality during the follow-up period using the Cox regression analysis. This relationship remained significant even after adjustment for other risk factors. HbA1c was also an independent predictor of total and cardiovascular mortality. In patients without diabetes mellitus, the small group of patients with macroalbuminuria (n=8) had a markedly increased cardiovascular mortality compared to both the microalbuminuric (n=94, P=0.0005) and the normoalbuminuric group (n=243, p<0.0001). No difference was observed between the normoalbuminuric and the microalbuminuric groups. Smoking and concomitant cardiovascular disease at entry were independent predictors of cardiovascular mortality in these patients. We conclude that microalbuminuria was an independent predictor for cardiovascular mortality in the group of treated hypertensive men with maturity-onset diabetes mellitus. Macroalbuminuria, but not microalbuminuria predicted cardiovascular mortality among the non-diabetic treated hypertensive men.