{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:11:55Z","timestamp":1790280715878,"version":"4.1.0"},"reference-count":23,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"unspecified","delay-in-days":139,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,5,7]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction\/aims<\/jats:title>\n                  <jats:p>Evaluation of urinary albumin-to-creatinine ratio (uACR) is a key component in the management of hypertension, yet there is a lack of data on the association between uACR and major cardiovascular events (MACEs) in large hypertensive cohorts, and it is also unknown how often uACR is measured among these patients.<\/jats:p>\n                  <jats:p>We aimed to evaluate the usage of uACR in a nationwide population of patients with hypertension. Furthermore, we sought to assess the risk of cardiorenal events according to uACR, among patients with hypertension.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We used Danish nationwide registries to identify patients who initiated antihypertensive treatment. The patients were grouped at treatment initiation according to uACR: normoalbuminuria, microalbuminuria, macroalbuminuria and no uACR measurement, and followed for 2 years, to evaluate the risk of a MACE, hospitalisation for heart failure (HF), 40% decline in estimated glomerular filtration rate (eGFR) and end-stage kidney disease (ESKD) according to uACR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We included 144\u2009644 patients, of whom 116\u2009039 (80%) did not have their uACR evaluated at treatment initiation. Patients with macroalbuminuria comprised the greatest 2\u2009year absolute risk of MACE (5.3%, 95% CI: 4.0% to 6.6%) and had a greater risk of MACE (HR: 2.02, 95% CI: 1.54 to 2.66), HF (HR: 1.99, 95% CI: 1.35 to 2.95), 40% decline in eGFR (HR: 4.81, 95% CI: 3.78 to 6.10) and ESKD (HR: 4.52, 95% CI: 3.00 to 6.82) compared with patients with normoalbuminuria. Increased risk of MACE, HF and 40% decline in eGFR among patients with macroalbuminuria was persistent across subgroups of eGFR 120\u201330\u2009mL\/min\/1.73\u2009m\u00b2.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>In this real-world cohort, uACR was not regularly measured among patients initiating antihypertensive treatment. Nonetheless, the 2-year risks of cardiorenal events were considerably higher among patients with albuminuria compared with patients without.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003270","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T06:40:15Z","timestamp":1747809615000},"page":"e003270","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Urinary albumin-to-creatinine ratio in patients with hypertension and risk of major cardiovascular events"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2220-0375","authenticated-orcid":false,"given":"Casper","family":"Binding","sequence":"first","affiliation":[{"name":"Cardiology, Herlev Hospital, Herlev, Denmark"},{"name":"Cardiology, Hvidovre hospital, Hvidovre, Denmark"},{"name":"Cardiology, Aalborg Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariam","family":"Elmegaard","sequence":"additional","affiliation":[{"name":"Cardiology, Herlev Hospital, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deewa Zahir","family":"Anjum","sequence":"additional","affiliation":[{"name":"Cardiology, Herlev Hospital, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Carlson","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Rigshospitalet, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Schou","sequence":"additional","affiliation":[{"name":"Cardiology, Herlev Hospital, Herlev, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders Nissen","family":"Bonde","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"2025081709302012000_12.1.e003270.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(74)91002-2"},{"key":"2025081709302012000_12.1.e003270.2","doi-asserted-by":"crossref","unstructured":"Peitzman SJ . Dropsy, dialysis, transplant: a short history of failing kidneys. JHU Press, 2007.","DOI":"10.56021\/9780801887345"},{"key":"2025081709302012000_12.1.e003270.3","doi-asserted-by":"publisher","DOI":"10.1177\/0004563212473284"},{"key":"2025081709302012000_12.1.e003270.4","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.123.030131","article-title":"Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease","volume":"13","author":"Barzilay","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"2025081709302012000_12.1.e003270.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac683"},{"key":"2025081709302012000_12.1.e003270.6","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1093\/eurheartj\/ehac528","article-title":"Albuminuria as a marker of systemic congestion in patients with heart failure","volume":"44","author":"Boorsma","year":"2023","journal-title":"Eur Heart J"},{"key":"2025081709302012000_12.1.e003270.7","doi-asserted-by":"crossref","first-page":"139","DOI":"10.4103\/bc.bc_64_20","article-title":"The role of urinary albumin-to-creatinine ratio as a biomarker to predict stroke: A meta-analysis and systemic review","volume":"7","author":"Li","year":"2021","journal-title":"Brain Circ"},{"key":"2025081709302012000_12.1.e003270.8","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy339"},{"key":"2025081709302012000_12.1.e003270.9","doi-asserted-by":"publisher","DOI":"10.1161\/HYPERTENSIONAHA.120.15026"},{"key":"2025081709302012000_12.1.e003270.10","doi-asserted-by":"publisher","DOI":"10.1097\/HJH.0000000000003480"},{"key":"2025081709302012000_12.1.e003270.11","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2023.26230","article-title":"Estimated Prevalence and Testing for Albuminuria in US Adults at Risk for Chronic Kidney Disease","volume":"6","author":"Chu","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2025081709302012000_12.1.e003270.12","doi-asserted-by":"publisher","DOI":"10.1161\/hypertensionaha.121.17323"},{"key":"2025081709302012000_12.1.e003270.13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"2025081709302012000_12.1.e003270.14","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1093\/ehjcvp\/pvab065","article-title":"Discontinuation of direct oral anticoagulants among patients with atrial fibrillation according to gender and cohabitation status: a nationwide cohort study","volume":"8","author":"Binding","year":"2022","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2025081709302012000_12.1.e003270.15","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1097\/EDE.0000000000000160","article-title":"The parametric g-formula for time-to-event data: intuition and a worked example","volume":"25","author":"Keil","year":"2014","journal-title":"Epidemiology (Sunnyvale)"},{"key":"2025081709302012000_12.1.e003270.16","unstructured":"Agency DDP . Legislation regarding the protection of data. 2023. Available: https:\/\/www.datatilsynet.dk\/hvad-siger-reglerne\/lovgivning"},{"key":"2025081709302012000_12.1.e003270.17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.4.421"},{"key":"2025081709302012000_12.1.e003270.18","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.08530815"},{"key":"2025081709302012000_12.1.e003270.19","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60674-5"},{"key":"2025081709302012000_12.1.e003270.20","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00040-6"},{"key":"2025081709302012000_12.1.e003270.21","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.17002"},{"key":"2025081709302012000_12.1.e003270.22","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012832","article-title":"Positive predictive value of cardiovascular diagnoses in the Danish National Patient Registry: a validation study","volume":"6","author":"Sundb\u00f8ll","year":"2016","journal-title":"BMJ Open"},{"key":"2025081709302012000_12.1.e003270.23","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz155"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2025-003270","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T16:30:30Z","timestamp":1755448230000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2025-003270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,5,21]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/openhrt-2025-003270"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2025-003270","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}