TY - JOUR
T1 - Proteinuria is an independent risk factor for first incident stroke in adults under treatment for hypertension in China
AU - Zhang, Chunyan
AU - Wang, Xiaobin
AU - He, Mingli
AU - Qin, Xianhui
AU - Tang, Genfu
AU - Xu, Xin
AU - Wang, Yu
AU - Huo, Yong
AU - Cai, Yefeng
AU - Fu, Jia
AU - Zhao, Gang
AU - Dong, Qiang
AU - Xu, Xiping
AU - Wang, Binyan
AU - Hou, Fan Fan
N1 - Publisher Copyright:
© 2015 The Authors.
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background-Conflicting evidence exists regarding whether reduced estimated glomerular filtration rate (eGFR) and proteinuria are independent risk factors for stroke and its subtypes in hypertensive patients. This study investigated the association of these renal measures with first incident stroke in adults under treatment for hypertension in China. Methods and Results-The study included 19 599 adults aged 45 to 75 years who participated in the China Stroke Primary Prevention Trial. Baseline eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Proteinuria was assessed by qualitative dipstick urinalysis and in a subset by the quantitative albumin-creatinine ratio method. Cox regression analysis was used to examine the effects of eGFR and proteinuria on the risk of first incident stroke. During a median of 4.5 years of follow-up, a total of 585 first strokes (472 ischemic strokes) were identified. Compared to participants without proteinuria, participants with proteinuria (trace or more by dipstick) had a 35% increased risk of first stroke: The adjusted hazard ratio (HR) (95% CI) was 1.35 (1.09-1.66, P=0.005). The results were robust in subgroup analyses. In a subset with data on proteinuria measured by quantitative albumin-creatinine ratio, a similar association was found. In both independent and combined analyses with proteinuria, eGFR was not significantly associated with stroke. Conclusions-In adults under treatment for hypertension in China, baseline proteinuria measured by dipstick or quantitative albumin-creatinine ratio, but not reduced eGFR, was found to be an independent risk factor for first incident stroke and ischemic stroke.
AB - Background-Conflicting evidence exists regarding whether reduced estimated glomerular filtration rate (eGFR) and proteinuria are independent risk factors for stroke and its subtypes in hypertensive patients. This study investigated the association of these renal measures with first incident stroke in adults under treatment for hypertension in China. Methods and Results-The study included 19 599 adults aged 45 to 75 years who participated in the China Stroke Primary Prevention Trial. Baseline eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Proteinuria was assessed by qualitative dipstick urinalysis and in a subset by the quantitative albumin-creatinine ratio method. Cox regression analysis was used to examine the effects of eGFR and proteinuria on the risk of first incident stroke. During a median of 4.5 years of follow-up, a total of 585 first strokes (472 ischemic strokes) were identified. Compared to participants without proteinuria, participants with proteinuria (trace or more by dipstick) had a 35% increased risk of first stroke: The adjusted hazard ratio (HR) (95% CI) was 1.35 (1.09-1.66, P=0.005). The results were robust in subgroup analyses. In a subset with data on proteinuria measured by quantitative albumin-creatinine ratio, a similar association was found. In both independent and combined analyses with proteinuria, eGFR was not significantly associated with stroke. Conclusions-In adults under treatment for hypertension in China, baseline proteinuria measured by dipstick or quantitative albumin-creatinine ratio, but not reduced eGFR, was found to be an independent risk factor for first incident stroke and ischemic stroke.
KW - Albumin-creatinine ratio
KW - Chinese hypertensive adults
KW - Estimated glomerular filtration rate
KW - First incident stroke
KW - proteinuria
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U2 - 10.1161/JAHA.115.002639
DO - 10.1161/JAHA.115.002639
M3 - Article
C2 - 26683219
AN - SCOPUS:84991521235
SN - 2047-9980
VL - 4
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 12
M1 - e002639
ER -