Renal function during antihypertensive treatment.
To determine the association of renal function and the course of blood pressure in antihypertensive therapy, we studied the changes in serum creatinine as a measure of renal function and in-treatment blood pressure in black and white hypertensive patients. We measured serum creatinine in 2125 mild and moderately hypertensive men during treatment over an average of 5 years. Both unadjusted mean initial and final serum creatinine of 758 blacks (113 and 117 mumol/L respectively) were significantly higher than those of 1367 whites (108 and 107 mumol/L), with a small increase of 4 mumol/L (p < 0.01) for blacks and a fall of 0.9 mumol/L (p > 0.05) for whites. Less than 2% of all patients attained or remained at a final serum creatinine of 177 mumol/L or more. Of this small group (3% blacks, 1.4% whites), 31% had proteinuria at entry. After stratification by in-treatment diastolic blood pressure (< 95 and > or = 95 mm Hg) in each race, mean slopes of reciprocal serum creatinine were estimated, adjusting for age at entry, initial serum creatinine, diastolic pressure, and body-mass index by analysis of covariance. The two adjusted mean slopes did not differ significantly within each race. Multiple regression analysis confirmed that in-treatment diastolic pressure was not independently associated with final serum creatinine. The change in renal function was most likely a reflection of regression towards the mean, and does not support the view that antihypertensive treatment is an important determinant of renal function in mild-to-moderate hypertensive patients. Patients with substantial renal insufficiency may have pre-existing intrinsic renal disease.
Madhavan
S
S
Albert Einstein College of Medicine, Department of Epidemiology and Social Medicine, Bronx, New York 10461.
Stockwell
D
D
Cohen
H
H
Alderman
M H
MH
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044383:Black People; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D003404:Creatinine / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000188:drug therapy* / Q000208:ethnology / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000209:etiology; D044465:White People
D000959:Antihypertensive Agents; D003404:Creatinine