Determinants of urinary albumin excretion reduction in essential hypertension: A long-term follow-up study.
OBJECTIVE
The objective of the present study was to assess factors related to long-term changes in urinary albumin excretion (UAE) of nondiabetic microalbuminuric (n = 252) or proteinuric hypertensive individuals (n = 58) in a prospective follow-up.


METHODS
After enrollment, patients were placed on usual care including nonpharmacological treatment and/or treatment with an antihypertensive drug regime to achieve blood pressure < 135/85 mmHg. Periodic UAE measurements were performed until regression or significant reduction (defined when UAE dropped > 50% from the initial values, plus reduction of UAE to < 30 mg/24 h for microalbuminuric patients and < 300 mg/24 h for proteinuric patients).


RESULTS
Among the microalbuminuric patients, 113 (44.8%) significantly reduced UAE after a mean follow-up of 18 months (range 12-69 months), 20.3/100 patients per year. Among the proteinuric patients, 29 (50%) significantly reduced UAE after a mean follow-up of 25 months (range 12-51 months), 20.2/100 patients per year. The baseline glomerular filtration rate, diastolic blood pressure and fasting glucose during follow-up were independent factors related to the regression or significant reduction in a Cox proportional hazard model. Regression of UAE was independently related to initial estimated glomerular filtration rate < or = 60 ml/min per 1.73 m (hazard ratio, 0.57; 95% confidence interval, 0.38-0.86; P = 0.001) and DBP > or = 90 mmHg achieved during the follow-up (hazard ratio, 0.57; 95% confidence interval, 0.38-0.86; P = 0.001), even when adjusted for age, gender, body mass index, fasting glucose, presence of treatment at the beginning of the study and treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers during the follow-up.


CONCLUSIONS
The reduction of urinary albumin excretion was linked to the preserved glomerular filtration rate and to adequate blood pressure control.
Pascual
Jose Maria
JM
Hypertension Clinics of Sagunto Hospital, University of Valencia, Spain.
Rodilla
Enrique
E
Miralles
Amparo
A
Gonzalez
Carmen
C
Redon
Josep
J
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000328:Adult; D000419:Albuminuria / Q000178:diet therapy / Q000188:drug therapy* / Q000652:urine; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D001794:Blood Pressure / Q000187:drug effects; D002121:Calcium Channel Blockers / Q000494:pharmacology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers