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Urinary albumin-to-creatinine ratio and the risk of first stroke in Chinese hypertensive patients treated with angiotensin-converting enzyme inhibitors

Hypertension Research volume 45, pages 116–124 (2022)Cite this article

Abstract

We aimed to evaluate the relationship of the albumin-to-creatinine ratio (ACR) with the risk of first stroke and examine possible effect modifiers in hypertensive patients. A total of 11,632 hypertensive participants with urinary ACR measurements and without a history of stroke from the China Stroke Primary Prevention Trial (CSPPT) were included in this analysis. The primary outcome was first stroke. Over a median follow-up of 4.4 years, 728 first strokes were identified, of which 633 were ischemic, 89 were hemorrhagic, and 6 were uncertain types. Overall, there was a significant positive association between natural log-transformed ACR and the risk of first stroke (HR, 1.11; 95% CI: 1.03–1.20) and first ischemic stroke (HR, 1.12; 95% CI: 1.03–1.22). Consistently, participants with ACR ≥ 10 mg/g had a significantly higher risk of first stroke (HR, 1.26; 95% CI: 1.06–1.50) and first ischemic stroke (HR, 1.33; 95% CI: 1.10–1.59) than those with ACR < 10 mg/g. Moreover, the association of ACR with first stroke was significantly stronger in participants with higher total homocysteine (tHcy) levels (<10 versus ≥ 10 μmol/L; P for interaction = 0.044). However, there was no significant association between ACR and first hemorrhagic stroke (per natural log [ACR] increment: HR, 1.02; 95% CI: 0.82–1.27). In summary, hypertensive patients with ACR ≥ 10 mg/g had a significantly increased risk of first stroke or first ischemic stroke. This positive association was more pronounced among participants with higher tHcy levels.

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Data availability

Data described in the manuscript, code book, and analytic code will be made available from the corresponding authors on request after the request is submitted and formally reviewed and approved by the Ethics Committee of the Institute of Biomedicine, Anhui Medical University, Hefei, China.

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Funding

The study was supported by the National Key Research and Development Program [2016YFE0205400, 2018ZX09739010, 2018ZX09301034003]; the Department of Science and Technology of Guangdong Province [2020B121202010]; the Science and Technology Planning Project of Guangzhou, China [201707020010]; the Science, Technology and Innovation Committee of Shenzhen [GJHS20170314114526143, JSGG20180703155802047]; the Economic, Trade and Information Commission of Shenzhen Municipality [20170505161556110, 20170505160926390, 201705051617070]; the Key Clinical Research Program of Southern Medical University [LC2019ZD005]; the High-level Matching Funds of Nanfang Hospital [2014070]; the Major New Drug Creation Technology Major Project [2020zx09201017]; the President Foundation of Nanfang Hospital, Southern Medical University [2017C007]; the President Foundation of Nanfang Hospital, Southern Medical University [2018Z009]; Outstanding Youth Development Scheme of Nanfang Hospital, Southern Medical University [2019J004]; and the National Natural Science Foundation of China [82000691, 81973133, 81730019].

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Authors and Affiliations

  1. Division of Nephrology, Nanfang Hospital, Southern Medical University; National Clinical Research Center for Kidney Disease; State Key Laboratory of Organ Failure Research; Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangdong Provincial Clinical Research Center for Kidney Disease, Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, 510515, China

    Panpan He, Yaya Yang, Jianwei Tian, Manqiu Yang, Zizhen Lin, Huan Li, Yuanyuan Zhang, Mengyi Liu, Chun Zhou, Zhuxian Zhang, Youbao Li, Xiping Xu, Xianhui Qin & Min Liang

  2. Department of Cardiology, Peking University First Hospital, Beijing, 100034, China

    Yan Zhang, Jianping Li & Yong Huo

  3. Beijing Advanced Innovation Center for Food Nutrition and Human Health, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China

    Xiping Xu

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Contributions

Min Liang, XX, and XQ designed the research; Min Liang, PH, HL, Yuanyuan Zhang, YY, Mengyi Liu, CZ, ZZ, ZL, JT, and MY contributed to data collection; PH and Yuanyuan Zhang analyzed data; Min Liang, PH, and XQ wrote the paper; All authors reviewed/edited the manuscript for important intellectual content; All authors read and approved the final manuscript.

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Correspondence to Xianhui Qin or Min Liang.

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He, P., Yang, Y., Tian, J. et al. Urinary albumin-to-creatinine ratio and the risk of first stroke in Chinese hypertensive patients treated with angiotensin-converting enzyme inhibitors. Hypertens Res 45, 116–124 (2022). https://doi.org/10.1038/s41440-021-00780-5

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