title: Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy.
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.
authors.affiliation: Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA. jflack@med.wayne.edu
authors.forename: John M
authors.initials: JM
authors.lastname: Flack
authors.forename: Karl
authors.initials: K
authors.lastname: Duncan
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Ohmit
authors.forename: Ruth
authors.initials: R
authors.lastname: Quah
authors.forename: Xuefeng
authors.initials: X
authors.lastname: Liu
authors.forename: Preeti
authors.initials: P
authors.lastname: Ramappa
authors.forename: Sandra
authors.initials: S
authors.lastname: Norris
authors.forename: Lowell
authors.initials: L
authors.lastname: Hedquist
authors.forename: Amanda
authors.initials: A
authors.lastname: Dudley
authors.forename: Samar A
authors.initials: SA
authors.lastname: Nasser
mesh_terms: 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
chemical_list: D000959:Antihypertensive Agents