Albuminuria Signals Higher Cardiorenal Risk in Hypertensive Patients: Danish Study
Denmark: A large-scale Danish study has highlighted the critical importance of evaluating urinary albumin-to-creatinine ratio (uACR) in individuals beginning treatment for hypertension. The findings, published in the BMJ journal Open Heart and led by Casper Binding from the Department of Cardiology, Hvidovre Hospital, Denmark, suggest that the presence of albuminuria, particularly in its severe form (macroalbuminuria), substantially raises the risk of serious cardiovascular and kidney-related outcomes.
Researchers analyzed data from 144,644 patients who initiated antihypertensive therapy using nationwide health registries in Denmark.
The following were the key findings of the study:
- Urinary albumin-to-creatinine ratio (uACR) testing was not conducted in 80% of patients at the initiation of antihypertensive treatment.
- Patients with macroalbuminuria faced a significantly higher risk of major adverse cardiovascular events (MACE), heart failure, and kidney-related complications during a two-year follow-up period.
- The absolute risk of MACE in individuals with macroalbuminuria was 5.3%, more than twice that of patients with normal uACR levels (HR 2.02).
- These patients had an almost twofold increased risk of hospitalization due to heart failure (HR 1.99).
- They were over four times more likely to progress to end-stage kidney disease (HR 4.52).
- The risk of experiencing a 40% decline in kidney function was also more than four times higher in this group (HR 4.81).
- These increased risks were consistently observed across various levels of baseline kidney function (eGFR between 30 and 120 mL/min/1.73 m²).
The research emphasizes the clinical significance of albuminuria as a strong marker for future cardiorenal complications in newly treated hypertensive patients. Although existing international guidelines advocate routine measurement of uACR in hypertension management, the low rate of testing observed in this real-world cohort raises concerns about missed opportunities for early risk identification.
“Despite current recommendations, uACR is underutilized in routine clinical practice, yet our findings show that patients with elevated uACR levels—especially macroalbuminuria—are at markedly higher risk for both cardiovascular and renal complications,” the authors noted.
The study's authors advocate for more widespread implementation of uACR screening at the time of initiating antihypertensive therapy. They argue that identifying even early signs of albumin leakage in urine could help clinicians stratify patients based on their risk and tailor management strategies more effectively.
While the research reinforces the importance of uACR in predicting outcomes, the authors also suggest further studies to explore how albuminuria levels interact with precise blood pressure measurements, which could potentially improve the identification of high-risk patients.
"The study brings to light a significant gap in routine hypertension care and offers strong evidence that more frequent evaluation of uACR could play a pivotal role in preventing future cardiovascular and kidney-related events in this vulnerable patient population," the researchers concluded.
Reference:
Binding C, Elmegaard M, Anjum DZ, Carlson N, Schou M, Bonde AN. Urinary albumin-to-creatinine ratio in patients with hypertension and risk of major cardiovascular events. Open Heart. 2025 May 21;12(1):e003270. doi: 10.1136/openhrt-2025-003270. PMID: 40398961; PMCID: PMC12097050.
