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'Hypertension' and 'microalbuminuria': the bell tolls for thee

J P Forman1, B M Brenner

  • 1Harvard Medical School, Boston, Massachusetts, USA. jforman@partners.org

Kidney International
|December 24, 2005
PubMed

Insights

The continuous relationship between blood pressure, albumin excretion, and cardiovascular disease suggests current diagnostic terms like hypertension and microalbuminuria are inadequate. Lowering these markers reduces cardiovascular risk, challenging established

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Public Health

Background:

  • Numerous studies demonstrate a continuous relationship between blood pressure, albumin excretion, and cardiovascular disease risk.
  • Lower blood pressure (e.g., 115/75 mmHg) and albumin excretion (e.g., <2 mg/day) are associated with reduced cardiovascular risk.
  • Modern lifestyle factors may have shifted 'normal' physiological values, creating 'neo-normal' standards.

Purpose of the Study:

  • To challenge the dichotomous definitions of hypertension and microalbuminuria.
  • To propose alternative terminology reflecting the continuous nature of disease risk.
  • To advocate for a re-evaluation of 'normal' physiological standards in light of evolutionary and modern lifestyle factors.

Main Methods:

  • Review of existing epidemiological and clinical data on blood pressure, albuminuria, and cardiovascular outcomes.
  • Comparative analysis of physiological norms across different populations and lifestyles.
  • Hypothesis generation based on evolutionary mismatch between Paleolithic genotype and modern environment.

Main Results:

  • Data support a continuous, graded association between blood pressure, albumin excretion, and cardiovascular risk, rather than distinct thresholds.
  • Current 'normal' ranges for blood pressure and albuminuria may not reflect optimal cardiovascular health.
  • The terms 'hypertension' and 'microalbuminuria' may oversimplify complex risk relationships.

Conclusions:

  • The medical community should consider abandoning the terms 'hypertension' and 'microalbuminuria'.
  • Alternative terms like 'blood pressure-associated disease' and 'albuminuria-associated disease' are proposed.
  • Revising diagnostic standards is crucial for accurate cardiovascular risk assessment and management.

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