Urine albumin-to-creatinine ratio within the normal range and risk of hypertension in the general population: A meta-analysis

Inconsistent findings on the association between urine albumin-to-creatinine ratio (UACR) and risk of hypertension have been reported. This meta-analysis sought to evaluate the association between the elevated level of UACR within the normal range and incident hypertension in the general population. We comprehensively searched PubMed and Embase databases until July 31, 2020. All longitudinal observational studies that assessed the association of elevated baseline level of UACR within the normal range with incident hypertension in the general population were included. The predictive value was estimated by pooling risk ratio (RR) with 95% confidence intervals (CI) for the highest versus the lowest category of UACR level. Nine articles (10 studies) involving 27 771 individuals were identified and analyzed. When compared with the lowest category of UACR, individuals with the highest UACR had a 1.75-fold (RR 1.75; 95% CI 1.47-2.09; p < .001) higher risk of hypertension in a random effect model. Gender-specific analysis indicated that the impact of UACR on the development of hypertension seemed to be stronger in women (RR 2.47; 95% CI 1.10-5.55; p = .029) than in men (RR 1.88; 95% CI 1.35-2.61; p < .001). An increased UACR within the normal range is independently associated with a higher risk of hypertension in the general population. Baseline UACR can be served as a predictor of incident hypertension in the general population.