Brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria in patients with essential hypertension - A Japanese trial on the prognostic implication of pulse wave velocity (J-TOPP)

Brachial-ankle pulse wave velocity is a new measure of arterial stiffness. The clinical significance of brachial-ankle pulse wave velocity as a measure of early vascular damage remains unclear. We examined the hypothesis that higher brachial-ankle pulse wave velocity is associated with a much greater risk of albuminuria by employing a cohort of 718 never-treated hypertensive patients registered in a prospective study. The 718 patients consisted of 500 patients with normoalbuminuria (69.6%), 191 patients with microalbuminuria (26.6%) and 27 patients with macroalbuminuria (3.8%). The prevalence of microalbuminuria increased with a graded increase in brachial-ankle pulse wave velocity (17.6, 22.8, 28.2 and 39.6%, p<0.0001). The prevalence of macroalbuminuria remained constant until the third grade group of the brachial-ankle pulse wave velocity but increased significantly in the highest grade group compared with the lower grade groups (2.3, 3.2, 2.3, 9.9%, p<0.0001). Age, systolic and diastolic blood pressure, pulse pressure, heart rate, and fasting glucose concentration were also significantly increased with an increase in brachial-ankle pulse wave velocity (p<0.0001 for all). Multiple logistic regression analysis has shown that systolic blood pressure, fasting blood glucose, and brachial-ankle pulse wave velocity are significant risk factors for microalbuminuria. After adjusting for other risk factors, the odds ratio for an increase of 200 cm/s in brachial-ankle pulse wave velocity was 1.192 (95% confidence interval: 1.022-1.365; p<0.05). These data suggest that brachial-ankle pulse wave velocity is an independent risk factor for microalbuminuria and could be used as a marker for early vascular damage in never-treated hypertensive patients.