Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy.
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.
Flack
John M
JM
Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA. jflack@med.wayne.edu
Duncan
Karl
K
Ohmit
Suzanne E
SE
Quah
Ruth
R
Liu
Xuefeng
X
Ramappa
Preeti
P
Norris
Sandra
S
Hedquist
Lowell
L
Dudley
Amanda
A
Nasser
Samar A
SA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000503:physiopathology*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D003971:Diastole / Q000502:physiology; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D013599:Systole / Q000502:physiology; D014505:Urban Population
D000959:Antihypertensive Agents