Display Settings:

Format

Send to:

Choose Destination
Am J Hypertens. 2013 Sep;26(9):1148-54. doi: 10.1093/ajh/hpt074. Epub 2013 Jun 8.

Urinary albumin excretion at follow-up predicts cardiovascular outcomes in subjects with resistant hypertension.

Author information

  • 1Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Barcelona, Catalonia, Spain.

Abstract

BACKGROUND:

Renal function and albuminuria predict cardiovascular disease (CVD) in general population. However, their prognostic value in patients with resistant hypertension (RH) is somewhat unknown.

OBJECTIVE:

To determine the ability of renal function and albuminuria to predict CVD in RH patients.

METHODS:

One hundred and thirty-three RH (blood pressure [BP] ≥140/90mmHg despite treatment with ≥3 drugs) patients were evaluated. Median follow-up was 73 months. Primary endpoint was a composite of non-fatal cardiovascular events or cardiovascular death. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were determined. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) ≥30mg/g.

RESULTS:

Twenty-two patients (16.5%) reached the primary endpoint. Long-term elevated UACR (66 vs. 17mg/g, P=0.045), but not at baseline, was associated with the primary endpoint, after adjusting for age, prior CVD, and both eGFR and office systolic-BP at baseline and during follow-up. Although baseline SCr and eGFR were associated with CVD, significance was lost after baseline risk adjustment. Baseline microalbuminuria prevalence was 45% and 41% in patients with and without CVD (P=0.813), while percentages of patients with microalbuminuria at follow-up were 67% and 28%, respectively (P=0.002). More patients with de novo CVD, compared with those without CVD, developed microalbuminuria at follow-up (28% vs. 6%) or had persistent microalbuminuria (39% vs. 21%), while fewer patients with CVD had microalbuminuria regression (11% vs. 19%) or remained normoalbuminurics (22% vs. 53%; overall P=0.005).

CONCLUSION:

In RH patients, the inability to microalbuminuria regression, either due to persistence or new appearance, independently predicts CVD.

KEYWORDS:

blood pressure; cardiovascular disease; cardiovascular outcomes; hypertension; microalbuminuria; resistant hypertension; urinary albumin excretion

PMID:
23747954
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Icon for HighWire
    Loading ...
    Write to the Help Desk