title: Prognostic importance of baseline and serial changes in microalbuminuria in patients with resistant hypertension.
abstract: OBJECTIVE
  The prognostic value of microalbuminuria is unsettled in resistant hypertension. The objective was to evaluate the importance of baseline and serial changes in albuminuria as predictors of cardiovascular morbidity and mortality in patients with resistant hypertension.
  
  
  METHODS
  531 resistant hypertensives had urinary albumin excretion rate (UAER) measured prospectively at baseline and at the 2nd year of follow-up. Primary endpoints were a composite of fatal and non-fatal cardiovascular events, all-cause and cardiovascular mortalities. Total strokes and coronary heart disease (CHD) events were secondary endpoints. Multiple Cox regression assessed the associations between UAER and endpoints.
  
  
  RESULTS
  After a median follow-up of 4.9 years, 72 patients died, 42 from cardiovascular causes; 96 cardiovascular events occurred, 42 strokes and 47 CHD events. After adjustment for several cardiovascular risk factors, baseline UAER, either analyzed as a continuous variable or dichotomized at different cut-off values, was an independent predictor of the composite endpoint, all-cause and cardiovascular mortality, strokes and CHD events. Each 10-fold increase in UAER implied a significant 1.6, 1.5, 2.0, 1.5 and 1.6-fold higher risk, respectively, for each of the above endpoints. Serial changes in microalbuminuria status during follow-up tended to parallel changes in cardiovascular risk, regression of microalbuminuria was associated with a 27% lower risk and development with a 65% higher risk of having a cardiovascular event.
  
  
  CONCLUSIONS
  Baseline albuminuria strongly predicts cardiovascular morbidity and mortality in resistant hypertensive patients and serial changes in microalbuminuria may translate into changes in risk. Microalbuminuria reduction may be a goal of anti-hypertensive treatment.
authors.affiliation: Department of Internal Medicine, University Hospital Clementino Fraga Filho, Medical School, Federal University of Rio de Janeiro, Brazil. gilsalles@hucff.ufrj.br
authors.forename: Gil F
authors.initials: GF
authors.lastname: Salles
authors.forename: Claudia R L
authors.initials: CR
authors.lastname: Cardoso
authors.forename: Roberto
authors.initials: R
authors.lastname: Fiszman
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Muxfeldt
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology* / Q000401:mortality; D000704:Analysis of Variance; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001938:Brazil / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000473:pathology; D016009:Chi-Square Distribution; D004351:Drug Resistance; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents