Abstract Body (Do not enter title and authors here): Background
Elevated blood pressure and albuminuria are well-established independent risk factors for cardiovascular disease (CVD). Studies have evaluated the relationship between hypertension, normotension, and albuminuria. However, there are limited studies on the impact of both pre-hypertension and albuminuria on CVD risk.
Research Question
How do prehypertensive blood pressure levels and albuminuria jointly impact CVD risk?
Methods
In this cross-sectional analysis, we utilized data from the National Health and Nutrition Examination Survey (2007-2018) and included adults ≥ 20 years who were prehypertensive and not on any antihypertensive medications. This study incorporated adjustments for the survey’s sampling design. Participants were stratified into two groups based on their BP and albuminuria status as follows: Group 1: prehypertension without albuminuria, and Group 2: prehypertension with albuminuria. Prehypertension was defined as systolic BP 120-129 and diastolic BP < 80 mmHg. Albuminuria was defined as Urine albumin/Creatinine >30mg/g. CVD was defined as a composite of stroke, angina, coronary heart disease, heart failure, and myocardial infarction. Multivariable logistic regression models were used to evaluate the association of prehypertension and albuminuria with CVD, adjusting for age, sex, race, education, insurance, body mass index, and glycosylated hemoglobin.

Results
The study included 3,683 participants with prehypertension (mean age = 46±17 years). Group 1 comprised 3,391 participants who did not have Albuminuria, while Group 2 included 292 participants who had Albuminuria. Compared to patients with pre-hypertension without albuminuria, those with pre-hypertension and albuminuria had higher odds of CVD (odds ratio OR: 3.07, 95% CI: 1.95-4.84) in the unadjusted model. After adjusting for the covariates, prehypertension with albuminuria was significantly associated with higher odds of CVD compared to those with prehypertension but without albuminuria (adjusted OR: 1.80, 95% CI: 1.03-3.14).

Conclusions
This study highlights the relationship between prehypertension and albuminuria in CVD outcomes. Our findings emphasize the need for proactive monitoring of albumin levels in patients with prehypertension. Further studies are needed to evaluate the impact of albuminuria on subclinical cardiovascular disease outcomes.