Cumulative systolic BP and changes in urine albuminto-creatinine ratios in nondiabetic participants of the multi-ethnic study of atherosclerosis

Background and objectives Cumulative exposure to elevated systolic BP (cumSBP) may affect progression of urine albumin excretion in the absence of diabetes. The objective of this study was to examine the association between cumSBP exposure and progression of spot urine albumin-to-creatinine ratio (UACR) in a multi-ethnic cohort of adults without diabetes. Design, setting, participants,&measurements The analysis included 3789 participants without severely increased urine albumin excretion or diabetes in the Multi-Ethnic Study of Atherosclerosis, a cohort of 6814 adults aged 45– 84 years. UACR was measured at baseline and approximately 1.6, 3.1, and 9.4 years after the baseline examination. cumSBP was calculated as the summed average systolic BP (SBP; mmHg) between two consecutive examinations multiplied by the time between the two examinations (mmHg×year) and categorized as ≤ (SBP <120 mmHg), 1129–1222 (SBP≥120–129 mmHg), 1223–1316 (SBP≥130–130 mmHg), and.1316 (SBP≥140 mmHg). Baseline UACR was categorized as normal, mildly increased, or moderately increased, and definite progression of UACR was defined as a persistently higher UACR category at subsequent examinations. No UACR progression was defined as remaining in the same UACR category across all examinations or regressing. Results In fully adjusted models, compared with cumSBP≤ mmHg, cumSBP 1223–1316 and >1316 mmHg was associated with a 85% and 130% significantly higher odds of definite UACR progression (95% confidence interval, 24% to 178% and 56% to 243%, respectively) versus no UACR progression. Every 100-mmHg higher level of cumSBP was associated with a 1.23-fold higher odds of definite UACR progression (95% confidence interval, 1.13 to 1.34) versus no UACR progression. Conclusion Exposure to higher cumSBP was associatedwith increased UACR progression among adults without diabetes.