Korean J Health Promot KJHP Korean Journal of Health Promotion 2234-2141 2093-5676 Korean Society for Health Promotion and Disease Prevention 10.15384/kjhp.2019.19.4.202 Original Article Relationship between Hypertension and Mircroalbuminuria according to Obesity Status in Prediabetes https://orcid.org/0000-0002-4650-3047 Chu Jieun https://orcid.org/0000-0002-6432-5897 Cho Seon https://orcid.org/0000-0003-0512-1189 Kim Suyoung https://orcid.org/0000-0003-2293-5782 Kwon Eunjoo https://orcid.org/0000-0003-0637-4364 Nah Eun-Hee Health Promotion Research Institute, Korea Association of Health Promotion, Seoul, Korea. Corresponding author: Eun-Hee Nah, MD, PhD. Health Promotion Research Institute, Korea Association of Health Promotion, 395 Gonghang-daero, Gangseo-gu, Seoul 07649, Korea. Tel: +82-2-2600-0107, Fax: +82-2-2690-4915, cellonah@hanmail.net 12 2019 31 12 2019 19 4 202 209 05 08 2019 18 10 2019 12 11 2019 Copyright © 2019 Korean Society for Health Promotion and Disease Prevention 2019 Korean Society for Health Promotion and Disease Prevention This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

Microalbuminuria (MA) is a predictor for diabetic nephropathy and mortality of cardiovascular disease. Diabetic nephropathy can be prevented by blood glucose and blood pressure control. Koreans have been found to have a significantly higher risk of type 2 diabetes than Caucasians, despite having normal weights. It is necessary to consider obesity status in the prevention of type 2 diabetes. This study aimed to determine the relationship between MA and hypertension according to obesity status in prediabetes.

 Methods

This study was retrospectively conducted in 1,183 prediabetes, aged 30-70 years with fasting blood glucose levels of 100-125 mg/dL or hemoglobin A1c levels of 5.7–6.4% who health examinees at 16 health promotion centers from 2015 to 2016. Study subjects were classified according to obesity and hypertension. Obesity is defined as body mass index of ≥25 kg/m2. Blood pressure was categorized as follows: normal blood pressure, <120/80 mmHg; prehypertension, 120–139/80–89 mmHg; and hypertension, ≥140/90 mmHg. We analyzed the relationship between MA and hypertension according to obesity using multivariable logistic regression analysis.

 Results

While both prehypertensive and hypertensive subgroups were significantly associated with MA in the nonobese, the hypertensive subgroup was only associated with MA in the obese. In the combined effects of obesity and hypertension, prediabetes with normal weight and hypertension had the highest risk of MA (adjusted odds ratio, 6.39; 95% confidence interval, 2.90–14.10) compared to those with nonobese and normal blood pressure.

 Conclusions

Our findings suggest that nonobese prediabetes with hypertension would need to be more concerned about MA than do obese prediabetes with hypertension.

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Characteristics of the study subjects according to obesity status

Values are presented as mean±standard deviation or number (%).

Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; FBS, fasting blood sugar; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MA, microalbuminuria; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride.

aThe Student's t-test or chi-square test were used.

 Microalbuminuria and clinical characteristics of study subjects according to the status of obesity and blood pressure

Values are presented as mean±standard deviation or number (%).

Abbreviations: BMI, body mass index; DBP, diastolic blood pressure; FBS, fasting blood sugar; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MA, microalbuminuria; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride.

aThe ANOVA or chi-square test were used.

 Association between hypertension status and microalbuminuria in non-obese and obese group

Model 1: a univariable logistic regression model. Model 2: a multivariable logistic regression model adjusted for sex, age, diabetes family history. Model 3: a multivariable logistic regression model adjusted for sex, age, diabetes family history, FBS, HbA1c, TC, TG, LDL-C, HDL-C.

Abbreviations: CI, confidence interval; FBS, fasting blood sugar; HbA1c, hemoglobin A1c; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; MA, microalbuminuria; OR, odds ratio; TC, total cholesterol; TG, triglyceride.

aOR and 95% CI are calculated with logistic regression.

 Analysis for evaluating the combined effect of obesity and hypertension status on microalbuminuria in the study subjects

Abbreviations: BP, blood pressure; CI, confidence interval; MA, microalbuminuria; OR, odds ratio.

aAdjusted for age, sex, diabetes family history, fasting blood sugar, hemoglobin A1c, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol.

bOR and 95% CI are calculated with multiple logistic regression.