Skip to main content

Advertisement

SpringerLink
Log in

Smoking is associated with a high prevalence of microalbuminuria in hypertensive high-risk patients: data from I-SEARCH

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Microalbuminuria (MAU) is a marker of endothelial dysfunction and a predictor of cardiovascular events. The effects of cigarette smoking on the prevalence of MAU in a high-risk population with arterial hypertension are unclear.

Methods

The International Survey Evaluating Microalbuminuria Routinely by Cardiologists in patients with Hypertension (I-SEARCH) documented the clinical profile of 20,364 patients with arterial hypertension and cardiovascular risk factors. In this population, 13,690 patients had no history of smoking, 4,057 patients were former smokers and 2,617 patients were current smokers.

Results

The prevalence of MAU was associated with the smoking status. Consumption of 1–20 cigarettes per day leads to an increase of 6.8% in the prevalence of MAU compared to non-smokers (P < 0.001). Smoking of >20 cigarettes per day was associated with a 12.5% higher prevalence of MAU compared to non-smokers, while former smokers had a 4.7% higher prevalence of MAU. Multivariable analysis revealed that smoking was independently associated with MAU [odds ratio (OR) smoking vs. non-smoking 1.16; 95% confidence interval (CI) 1.01–1.33; P < 0.05]. Particularly, a consumption of >20 cigarettes per day was associated with high odds for MAU (OR 1.33; CI 1.01–1.75; P < 0.05). Interestingly, independently of blood pressure, the use of an angiotensin receptor blocker and an ACE was associated with significantly reduced odds ratio for MAU in the smoking group, while there was no significant association in the non-smoking group.

Conclusion

The prevalence of MAU in hypertensive patients is higher in smokers than in non-smokers with a strong dose dependency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Centers for Disease Control and Prevention (2002) Annual smoking-attributable mortality, years of potential life lost, and economic costs—United States, 1995–1999. MMWR Morb Mortal Wkly Rep 51:300–303

    Google Scholar 

  2. Holbrook JH, Grundy SM, Hennekens CH, Kannel WB, Strong JPl (1984) Cigarette smoking and cardiovascular diseases. A statement for health professionals by a task force appointed by the steering committee of the American Heart Association. Circulation 70:1114A–1117A

    CAS  PubMed  Google Scholar 

  3. Sherman CB (1992) The health consequences of cigarette smoking. Pulmonary diseases. Med Clin North Am 76:355–375

    CAS  PubMed  Google Scholar 

  4. Orth SR, Ritz E, Schrier RW (1997) The renal risks of smoking. Kidney Int 51:1669–1677

    Article  CAS  PubMed  Google Scholar 

  5. Deckert T, Feldt-Rasmussen B, Borch-Johnsen K, Jensen T, Kofoed-Enevoldsen A (1989) Albuminuria reflects widespread vascular damage. The Steno hypothesis. Diabetologia 32:219–226

    Article  CAS  PubMed  Google Scholar 

  6. Pedrinelli R, Giampietro O, Carmassi F, Melillo E, Dell’Omo G, Catapano G et al (1994) Microalbuminuria and endothelial dysfunction in essential hypertension. Lancet 344:14–18

    Article  CAS  PubMed  Google Scholar 

  7. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B et al (2001) Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 286:421–426

    Article  CAS  PubMed  Google Scholar 

  8. Stephenson JM, Kenny S, Stevens LK, Fuller JH, Lee E (1995) Proteinuria and mortality in diabetes: the WHO Multinational Study of Vascular Disease in Diabetes. Diabet Med 12:149–155

    Article  CAS  PubMed  Google Scholar 

  9. Ekberg G, Grefberg N, Larsson LO, Vaara I (1990) Cigarette smoking and glomerular filtration rate in insulin-treated diabetics without manifest nephropathy. J Intern Med 228:211–217

    Article  CAS  PubMed  Google Scholar 

  10. Pinto-Sietsma SJ, Mulder J, Janssen WM, Hillege HL, de Zeeuw D, de Jong PE (2000) Smoking is related to albuminuria and abnormal renal function in nondiabetic persons. Ann Int Med 133:585–591

    CAS  PubMed  Google Scholar 

  11. Böhm M, Thoenes M, Danchin N, Bramlage P, La Puerta P, Volpe M (2007) Association of cardiovascular risk factors with microalbuminuria in hypertensive individuals: the i-SEARCH global study. J Hypertens 25:2317–2324

    Article  PubMed  Google Scholar 

  12. Cockcroft DW, Gault MH (1976) Prediction of creatinine clearance from serum creatinine. Nephron 16:31–41

    Article  CAS  PubMed  Google Scholar 

  13. Schmieder RE, Schrader J, Zidek W, Tebbe U, Paar WD, Bramlage P et al (2007) Low-grade albuminuria and cardiovascular risk: what is the evidence? Clin Res Cardiol 96:247–257

    Article  CAS  PubMed  Google Scholar 

  14. Solomon SD, Lin J, Solomon CG, Jablonski KA, Rice MM, Steffes M et al (2007) Influence of albuminuria on cardiovascular risk in patients with stable coronary artery disease. Circulation 116:2687–2693

    Article  PubMed  Google Scholar 

  15. Böhm M, Reil JC, Danchin N, Thoenes M, Bramlage P, Volpe M (2008) Association of heart rate with microalbuminuria in cardiovascular risk patients: data from I-SEARCH. J Hypertens 26:18–25

    Article  PubMed  Google Scholar 

  16. Böhm M, Thoenes M, Neuberger HR, Gräber S, Reil JC, Bramlage P, Volpe M (2009) Atrial fibrillation and heart rate independently correlate to microalbuminuria in hypertensive patients. Eur Heart J 30:1364–1371

    Article  PubMed  Google Scholar 

  17. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G (2007) 2007 guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). J Hypertens 25:1105–1187

    Article  CAS  PubMed  Google Scholar 

  18. Parving HH, Lewis JB, Ravid M, Remuzzi G, Hunsicker LG (2006) DEMAND investigators prevalence and risk factors for microalbuminuria in a referred cohort of type II diabetic patients: a global perspective. Kidney Int 69:2057–2063

    Article  PubMed  Google Scholar 

  19. Couper JJ, Staples AJ, Cocciolone R, Nairn J, Badcock N, Henning P (1994) Relationship of smoking and albuminuria in children with insulin-dependent diabetes. Diabet Med 11:666–669

    Article  CAS  PubMed  Google Scholar 

  20. Mehler PS, Jeffers BW, Biggerstaff SL, Schrier RW (1998) Smoking as a risk factor for nephropathy in non-insulin-dependent diabetics. J Gen Intern Med 13:842–845

    Article  CAS  PubMed  Google Scholar 

  21. Cirillo M, Senigalliesi L, Laurenzi M, Alfieri R, Stamler J, Panarelli W et al (1998) Microalbuminuria in nondiabetic adults: relation of blood pressure, body mass index, plasma cholesterol levels, and smoking: the Gubbio population study. Arch Intern Med 158:1933–1939

    Article  CAS  PubMed  Google Scholar 

  22. Wachtell K, Olsen MH, Dahlof B, Devereux RB, Kieldsen SE, Nieminen MS et al (2002) Microalbuminuria in hypertensive patients with electrocardiographic left ventricular hypertrophy: the LIFE study. J Hypertens 20:405–412

    Article  CAS  PubMed  Google Scholar 

  23. Parving HH, Lehnert H, Brochner-Mortensen J, Gomis R, Andersen S, Arner P et al (2001) The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med 345:870–878

    Article  CAS  PubMed  Google Scholar 

  24. Werner C, Baumhäkel M, Teo KK, Schmieder R, Mann J, Unger T et al (2008) RAS blockade with ARB and ACE inhibitors: current perspective on rationale and patient selection. Clin Res Cardiol 97:418–431

    Article  CAS  PubMed  Google Scholar 

  25. Pawlik WW, Jacobson ED, Banks RO (1985) Actions of nicotine on renal function in dogs. Proc Soc Exp Biol Med 178:585–590

    CAS  PubMed  Google Scholar 

  26. Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB et al (2001) Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860

    Article  CAS  PubMed  Google Scholar 

  27. Zatz R, Dunn BR, Meyer TW, Anderson S, Rennke HG, Brenner BM (1986) Prevention of diabetic glomerulopathy by pharmacological amelioration of glomerular capillary hypertension. J Clin Invest 77:1925–1930

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The I-SEARCH program was supported by a grant from Sanofi-Aventis, Paris, France. MT is employee of Sanofi-Aventis. MB, MV, PB and RS received support from Sanofi-Aventis. CU, IK and MB are supported by the Deutsche Forschungsgemeinschaft (KFO 196) and the Ministry of Science and Education of the State of the Saarland, Germany.

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin III, Kardiologie, Angiologie, Internistische Intensivmedizin, Universität des Saarlandes, Universitätsklinikum, Kirrbergerstraße, 66421, Homburg/Saar, Germany

    Christian Ukena, F. Mahfoud, M. Kindermann, I. Kindermann & M. Böhm

  2. Institut für Medizinische Biometrie, Epidemiologie und Medizinische Informatik, Universität des Saarlandes, Homburg/Saar, Germany

    S. Gräber

  3. Medizinische Klinik 4, Nephrologie und Hypertensiologie, Universitätsklinikum Erlangen, Erlangen, Germany

    M. Schneider & R. Schmieder

  4. Institut für Kardiovaskuläre Pharmakologie und Epidemiologie, Mahlow, Germany

    P. Bramlage

  5. S. Andrea Hospital Rome Italy and IRCCS Neuromed, University of Rome “Sapienza”, Pozzilli, Italy

    M. Volpe

  6. Sanofi-Aventis, Paris, France

    M. Thoenes

  7. Medizinische Fakultät Carl Gustav Carus, Institut für Klinische Pharmakologie, TU Dresden, Dresden, Germany

    M. Thoenes

Authors
  1. Christian Ukena
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Mahfoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Kindermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Gräber
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. Kindermann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. Schmieder
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P. Bramlage
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Volpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Thoenes
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Böhm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Ukena.

Additional information

C. Ukena and F. Mahfoud contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ukena, C., Mahfoud, F., Kindermann, M. et al. Smoking is associated with a high prevalence of microalbuminuria in hypertensive high-risk patients: data from I-SEARCH. Clin Res Cardiol 99, 825–832 (2010). https://doi.org/10.1007/s00392-010-0194-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-010-0194-y

Keywords

Search

Navigation