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Higher brachial-ankle pulse wave velocity as an independent risk factor for future microalbuminuria in patients with essential hypertension: the J-TOPP study

Munakata, Masanori; Miura, Yukio; Yoshinaga, Kaoru; on behalf of the J-TOPP study group

Journal of Hypertension:
doi: 10.1097/HJH.0b013e32832b4740
Original papers: Kidney

Objective: Brachial-ankle pulse wave velocity (baPWV) is a new measure of arterial stiffness. We have shown that a higher baPWV is associated with more severe albuminuria in patients with essential hypertension. However, it is still unclear as to whether baPWV predicts the future albuminuria status in patients under standard care.

Methods: A total of 321 nondiabetic patients with essential hypertension who had normoalbuminuria or microalbuminuria and were receiving treatment under the current hypertension guidelines were followed up for 2 years. Resting BP, fasting blood glucose, urinary albumin excretion and baPWV were measured before treatment, and periodically thereafter for 2 years.

Results: A 2-year treatment regimen lowered BP from 156/93 to 135/81 mmHg (P < 0.0001) and reduced the incidence of microalbuminuria from 25.8 to 14.0%. To determine the predictors for future microalbuminuria status, we compared the baseline data between patients with normoalbuminuria (n = 276) and those with microalbuminuria (n = 45) 2 years after the treatment. The microalbuminuric patients had a significantly higher baPWV and urinary albumin excretion and a significantly lower high-density lipoprotein concentration than the normoalbuminuric patients. Furthermore, the frequency of the use of renin–angiotensin system inhibitors was significantly lower in the microalbuminuric patients than in the normoalbuminuric patients. A multiple logistic regression analysis showed that higher baPWV was an independent risk factor for microalbuminuria 2 years after treatment of hypertension. When we restricted our analysis to a cohort of patients without microalbuminuria at the baseline, we found that higher baPWV was an independent predictor of the development of microalbuminuria after 2 years.

Conclusion: Higher baPWV could be an independent risk factor for future microalbuminuria in patients with essential hypertension.

Author Information

Preventive Medical Centre, Tohoku Rosai Hospital, Dainohara, Aobaku, Sendai, Japan

Received 13 November, 2008

Revised 26 February, 2009

Accepted 5 March, 2009

Correspondence to Masanori Munakata, MD, PhD, Preventive Medical Centre, Tohoku Rosai Hospital, 3-21 Dainohara, 4 Aobaku, Sendai 981-8563, Japan Tel: +81 22 275 1111, ext 2214; fax: +81 22 273 6606; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.