title: Reduction in morning blood pressure is a key factor for ameliorating urinary albumin excretion in patients with morning hypertension irrespective of treatment regimen.
abstract: BACKGROUND
  The Morning Hypertension and Angiotensin Receptor Blocker/Hydrochlorothiazide Combination Therapy (MAPPY) study has shown that losartan/hydrochlorothiazide (HCTZ) combination is superior to high-dose losartan in not only reducing morning systolic blood pressure (SBP) but also ameliorating urinary albumin excretion (UAE) after 3-month treatment. The purpose of the present study was to investigate factors associated with UAE reduction in on-treatment patients with morning hypertension.
  
  
  RESULTS
  A total of 95 patients registered in the MAPPY study were analyzed. Patients were treated with either a losartan/HCTZ combination regimen (n=47) or a high-dose losartan regimen (n=48). Three-month treatment significantly reduced morning SBP, evening SBP, and clinic SBP (P<0.001, P<0.05, and P<0.01, respectively). UAE and serum uric acid were significantly decreased (P<0.01 for both) without the change in estimated glomerular filtration rate. Multiple linear regression analysis indicated that %morning SBP reduction and baseline UAE were independent determinants of the UAE reduction (P=0.001 for both). After adjustments for the reduction in morning-evening SBP difference, baseline UAE, and %uric acid reduction, estimated %UAE reduction level was positively correlated with the tertiles of the increasing %morning SBP reduction level (P=0.031 for trend). Moreover, subgroup analysis showed that morning SBP reduction was an independent determinant of UAE reduction in both treatment regimens.
  
  
  CONCLUSIONS
  Reduction in morning SBP was a key factor in UAE reduction in patients with morning hypertension, irrespective of treatment regimen.
authors: Department of Internal Medicine, Division of Cardio-Vascular Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan. naikai@med.kurume-u.ac.jp
authors: Hisashi
authors: H
authors: Kai
authors: Masashi
authors: M
authors: Kaneyuki
authors: Miwako
authors: M
authors: Shihara
authors: Yasuyuki
authors: Y
authors: Toyama
authors: Yoshiaki
authors: Y
authors: Mitsutake
authors: Hidekazu
authors: H
authors: Umei
authors: Ken
authors: K
authors: Kusaba
authors: Tamenobu
authors: T
authors: Ueda
authors: Hisashi
authors: H
authors: Adachi
authors: Tsutomu
authors: T
authors: Imaizumi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage*; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006852:Hydrochlorothiazide / Q000008:administration & dosage*; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000652:urine; D019808:Losartan / Q000008:administration & dosage*; D008875:Middle Aged; D013997:Time Factors
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D006852:Hydrochlorothiazide; D019808:Losartan