Editorial Comment
Proteinuria early in the development of hypertension Bo Carlberg
See original paper on page 2371
P
ersistent proteinuria is often the first sign of chronic kidney disease (CKD). CKD is closely related to an increased risk for cardiovascular disease (CVD) [1]. In patients with diabetes, the relation between proteinuria, renal insufficiency and CVD has been well known for many years. Also, in the general population, cohort studies have found that proteinuria is a risk factor for CVD and this risk increases with increasing proteinuria. The mechanism for the relation between proteinuria and CVD has suggested to be related to generalized vascular endothelial dysfunction. Elevated levels of inflammatory biomarkers are found together with proteinuria. Also, macrovascular endothelial dysfunction assessed by flow-mediated dilatation is impaired in individuals with proteinuria. A number of cohort studies have found that the development of proteinuria is related to baseline levels of blood pressure, glucose, cholesterol and BMI [2]. Most of these studies have only included blood pressure levels at baseline, not during follow-up. In this issue of the Journal of Hypertension, Yano et al. present interesting longitudinal data about blood pressure and proteinuria in a large Japanese nationwide cohort consisting of healthy men and women, wherein blood pressures have not only been measured at baseline but also after 3 years [3]. In their study, over 40 000 inhabitants without hypertension, CKD or CVD were followed for 3 years. During this relatively short time of observation, about 5% developed CKD [defined as an estimated glomerular filtration rate (eGFR)
Proteinuria early in the development of hypertension Bo Carlberg
See original paper on page 2371
P
ersistent proteinuria is often the first sign of chronic kidney disease (CKD). CKD is closely related to an increased risk for cardiovascular disease (CVD) [1]. In patients with diabetes, the relation between proteinuria, renal insufficiency and CVD has been well known for many years. Also, in the general population, cohort studies have found that proteinuria is a risk factor for CVD and this risk increases with increasing proteinuria. The mechanism for the relation between proteinuria and CVD has suggested to be related to generalized vascular endothelial dysfunction. Elevated levels of inflammatory biomarkers are found together with proteinuria. Also, macrovascular endothelial dysfunction assessed by flow-mediated dilatation is impaired in individuals with proteinuria. A number of cohort studies have found that the development of proteinuria is related to baseline levels of blood pressure, glucose, cholesterol and BMI [2]. Most of these studies have only included blood pressure levels at baseline, not during follow-up. In this issue of the Journal of Hypertension, Yano et al. present interesting longitudinal data about blood pressure and proteinuria in a large Japanese nationwide cohort consisting of healthy men and women, wherein blood pressures have not only been measured at baseline but also after 3 years [3]. In their study, over 40 000 inhabitants without hypertension, CKD or CVD were followed for 3 years. During this relatively short time of observation, about 5% developed CKD [defined as an estimated glomerular filtration rate (eGFR)
