Racial Disparity in the Associations of Microalbuminuria and Macroalbuminuria with Odds of Hypertension: Results from the NHANES Study in the United States
Background. Limited information is available on whether the associations of microalbuminuria and macroalbuminuria with the odds of hypertension differ among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. Methods. Cross-sectional data of 24,949 participants aged ≥18 years were collected from the National Health and Nutrition Examination Survey (NHANES) 1999–2008. Odds ratios of hypertension for microalbuminuria and macroalbuminuria were estimated by conducting weighted multiple logistic regression models. Results. After adjustment for extensive confounding factors, microalbuminuria is 1.45 (95% confidence interval (CI) [1.17, 1.80]), 2.07 (95% CI [1.52, 2.83]) and 2.81 (95% CI [2.06, 3.84]) times more likely to be associated with hypertension, and macroalbuminuria is 4.08 (95% CI [1.98, 8.38]), 8.62 (95% CI [3.84, 19.35]), and 4.43 (95% CI [2.13, 9.21]) times in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics, respectively. The odds of hypertension for microalbuminuria (versus normalbuminuria) were 52% higher in non-Hispanic Blacks and 98% higher in Hispanics than in non-Hispanic Whites; the odds of hypertension for macroalbuminuria (versus normalbuminuria) did not differ among racial groups. Conclusion. Racial differences in the relation between microalbuminuria and hypertension are prevalent among non-Hispanic Whites, non-Hispanic Blacks, and Hispanics. More screening efforts should be encouraged in normotensive non-Hispanic Blacks and Hispanics with microalbuminuria. 1. Introduction Hypertension has been a major public health concern that affects approximately 65 million people in the United States and is a major risk factor for cardiovascular and renal diseases [1–6]. Prevention of hypertension delays the progression of adverse cardiovascular and renal outcomes and reduces the morbidity and mortality related to these diseases. One of the goals in Healthy People 2020 is to reduce the proportion of US hypertensive adults to 26.9% [7]. Albuminuria is a clinical measure of extra albumin excretion occurring in the urine of the human body. The levels of albuminuria are usually determined by the ratio of spot urine albumin and creatinine. Microalbuminuria is defined as a urine albumin-to-creatinine ratio (UACR) ≥30？mg/g and <300？mg/g and macroalbuminuria as a UACR ≥300？mg/g [8, 9]. Conventionally, hypertension is considered an important risk factor for renal dysfunction, including the development of albuminuria [10, 11], and Blacks and Hispanics are more susceptible to renal damage from hypertension, leading to micro- and macroalbuminuria
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