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Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy.

Flack JM, Duncan K, Ohmit SE, Quah R, Liu X, Ramappa P, Norris S, Hedquist L, Dudley A, Nasser SA - Vasc Health Risk Manag (2007)

Bottom Line: In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73(2) predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001).Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA. jflack@med.wayne.edu

ABSTRACT

Background: Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods: We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results: Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73(2), 28% had micro-albuminuria (30-300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73(2) predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions: These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.

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Related in: MedlinePlus

Time to attainment of systolic and diastolic blood pressure goal (JNC-VII guidelines) by eGFR status.
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fig2: Time to attainment of systolic and diastolic blood pressure goal (JNC-VII guidelines) by eGFR status.

Mentions: Results from analyses of time-to-attainment of JNC BP goal stratified by albuminuria categories (Figure 1) indicated significant (Log-rank test p < 0.001) variation, with a significantly longer time to BP goal attainment for hypertensives with micro-albuminuria (median time 12.9-months [95% CI = 10.3 to 17.5]) or macro-albuminuria (median time 24.6-months [95% CI = 9.6 to infinity]) compared with those without albuminuria (median time 4.9-months [95% CI = 3.6 to 7.6]). Similarly, time-to-attainment of BP goal stratified by eGFR status (Figure 2) indicated significantly (Log-rank test p = 0.012) greater time to goal attainment for patients with eGFR <60 ml/min/1.732 (median time 12.9-months [95% CI = 9.1 to 18.4]) compared with those with values ≥60 ml/min/1.732 (median time 7.6-months [95% CI = 5.1 to 10.3]).


Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy.

Flack JM, Duncan K, Ohmit SE, Quah R, Liu X, Ramappa P, Norris S, Hedquist L, Dudley A, Nasser SA - Vasc Health Risk Manag (2007)

Time to attainment of systolic and diastolic blood pressure goal (JNC-VII guidelines) by eGFR status.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2350134&req=5

fig2: Time to attainment of systolic and diastolic blood pressure goal (JNC-VII guidelines) by eGFR status.
Mentions: Results from analyses of time-to-attainment of JNC BP goal stratified by albuminuria categories (Figure 1) indicated significant (Log-rank test p < 0.001) variation, with a significantly longer time to BP goal attainment for hypertensives with micro-albuminuria (median time 12.9-months [95% CI = 10.3 to 17.5]) or macro-albuminuria (median time 24.6-months [95% CI = 9.6 to infinity]) compared with those without albuminuria (median time 4.9-months [95% CI = 3.6 to 7.6]). Similarly, time-to-attainment of BP goal stratified by eGFR status (Figure 2) indicated significantly (Log-rank test p = 0.012) greater time to goal attainment for patients with eGFR <60 ml/min/1.732 (median time 12.9-months [95% CI = 9.1 to 18.4]) compared with those with values ≥60 ml/min/1.732 (median time 7.6-months [95% CI = 5.1 to 10.3]).

Bottom Line: In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73(2) predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001).Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA. jflack@med.wayne.edu

ABSTRACT

Background: Albuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.

Methods: We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results: Mean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.73(2), 28% had micro-albuminuria (30-300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.73(2) predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.

Conclusions: These data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR.

Show MeSH
Related in: MedlinePlus