C-reactive protein (CRP) and microalbuminuria reflect intimately related components of the atherosclerotic disease process. Epidemiological studies found only modest associations between CRP and microalbuminuria. Blood pressure, one of the components of the metabolic syndrome in the general population, is the main determinant of microalbuminuria in diabetes and hypertension. We questioned whether CRP modifies the relationship of blood pressure and other cardiovascular risk factors with

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... minuria in a cross-sectional study in 8592 inhabitants from Groningen, The Netherlands. The crude data showed an increase in the prevalence of microalbuminuria with increasing CRP quartiles (4.8, 9.6, 14.5, and 18.6%, PϽ0.0001). On stratification for cardiovascular risk factors, the data revealed a significant and positive interaction between mean arterial pressure (MAP) and quartiles of CRP with respect to the risk of microalbuminuria (Wald statistic 9.2, Pϭ0.03). In subjects with a MAP Ͻ90 mm Hg, a nonsignificant trend in the association between CRP quartiles and microalbuminuria was found (prevalence: 3.9%, 5.8%, 6.6%, 8.7%; Pϭ0.11). This trend was much steeper and significant in subjects with an MAP Ͼ90 mm Hg (prevalence: 6.7%, 13.6%, 20.4%, 25.1%; PϽ0.0001). Controlling for other risk factors in multivariate analyses, the positive interaction persisted (Pϭ0.0004). No significant interactions between other risk factors and CRP with respect to the risk of microalbuminuria were encountered. Thus, CRP modifies the relation between blood pressure and microalbuminuria. (Hypertension. 2004;43:791-796.) Key Words: cardiovascular diseases Ⅲ blood pressure Ⅲ risk factors Ⅲ kidney Ⅲ albuminuria C -reactive protein (CRP), a sensitive marker of (sub)clin-