title: Urinary albumin excretion is associated with nocturnal systolic blood pressure in resistant hypertensives.
abstract: Microalbuminuria is a known marker of subclinical organ damage. Its prevalence is higher in patients with resistant hypertension than in subjects with blood pressure at goal. On the other hand, some patients with apparently well-controlled hypertension still have microalbuminuria. The current study aimed to determine the relationship between microalbuminuria and both office and 24-hour ambulatory blood pressure. A cohort of 356 patients (mean age 64 ± 11 years; 40.2% females) with resistant hypertension (blood pressure ≥ 140 and/or 90 mm Hg despite treatment with ≥ 3 drugs, diuretic included) were selected from Spanish hypertension units. Patients with estimated glomerular filtration rate <30 mL/min/1.73 m(2) were excluded. All patients underwent clinical and demographic evaluation, complete laboratory analyses, and good technical-quality 24-hour ambulatory blood pressure monitoring. Urinary albumin/creatinine ratio was averaged from 3 first-morning void urine samples. Microalbuminuria (urinary albumin/creatinine ratio ≥ 2.5 mg/mmol in males or ≥ 3.5 mg/mmol in females) was detected in 46.6%, and impaired renal function (estimated glomerular filtration rate <60 mL/min/1.73 m(2)) was detected in 26.8%. Bivariate analyses showed significant associations of microalbuminuria with older age, reduced estimated glomerular filtration rate, increased nighttime systolic blood pressure, and elevated daytime, nighttime, and 24-hour diastolic blood pressure. In a logistic regression analysis, after age and sex adjustment, elevated nighttime systolic blood pressure (multivariate odds ratio, 1.014 [95% CI, 1.001 to 1.026]; P=0.029) and reduced estimated glomerular filtration rate (multivariate odds ratio, 2.79 [95% CI, 1.57 to 4.96]; P=0.0005) were independently associated with the presence of microalbuminuria. We conclude that microalbuminuria is better associated with increased nighttime systolic blood pressure than with any other office and 24-hour ambulatory blood pressure monitoring parameters.
authors.affiliation: Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain. aoliveras@hospitaldelmar.cat
authors.forename: Anna
authors.initials: A
authors.lastname: Oliveras
authors.forename: Pedro
authors.initials: P
authors.lastname: Armario
authors.forename: Nieves
authors.initials: N
authors.lastname: Martell-Clarós
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology / Q000652:urine*; D000704:Analysis of Variance; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002940:Circadian Rhythm / Q000502:physiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000652:urine*; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012737:Sex Factors