title: Urinary albumin excretion at follow-up predicts cardiovascular outcomes in subjects with resistant hypertension.
abstract: BACKGROUND
  Renal function and albuminuria predict cardiovascular disease (CVD) in general population. However, their prognostic value in patients with resistant hypertension (RH) is somewhat unknown.
  
  
  OBJECTIVE
  To determine the ability of renal function and albuminuria to predict CVD in RH patients.
  
  
  METHODS
  One hundred and thirty-three RH (blood pressure [BP] ≥140/90mmHg despite treatment with ≥3 drugs) patients were evaluated. Median follow-up was 73 months. Primary endpoint was a composite of non-fatal cardiovascular events or cardiovascular death. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were determined. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio (UACR) ≥30mg/g.
  
  
  RESULTS
  Twenty-two patients (16.5%) reached the primary endpoint. Long-term elevated UACR (66 vs. 17mg/g, P=0.045), but not at baseline, was associated with the primary endpoint, after adjusting for age, prior CVD, and both eGFR and office systolic-BP at baseline and during follow-up. Although baseline SCr and eGFR were associated with CVD, significance was lost after baseline risk adjustment. Baseline microalbuminuria prevalence was 45% and 41% in patients with and without CVD (P=0.813), while percentages of patients with microalbuminuria at follow-up were 67% and 28%, respectively (P=0.002). More patients with de novo CVD, compared with those without CVD, developed microalbuminuria at follow-up (28% vs. 6%) or had persistent microalbuminuria (39% vs. 21%), while fewer patients with CVD had microalbuminuria regression (11% vs. 19%) or remained normoalbuminurics (22% vs. 53%; overall P=0.005).
  
  
  CONCLUSIONS
  In RH patients, the inability to microalbuminuria regression, either due to persistence or new appearance, independently predicts CVD.
authors.affiliation: Hypertension Unit, Nephrology Department, Hospital Universitari del Mar, Barcelona, Catalonia, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Oliveras
authors.forename: Pedro
authors.initials: P
authors.lastname: Armario
authors.forename: Cristina
authors.initials: C
authors.lastname: Sierra
authors.forename: José A
authors.initials: JA
authors.lastname: Arroyo
authors.forename: Raquel
authors.initials: R
authors.lastname: Hernández-del-Rey
authors.forename: Susana
authors.initials: S
authors.lastname: Vazquez
authors.forename: María
authors.initials: M
authors.lastname: Larrousse
authors.forename: Laia
authors.initials: L
authors.lastname: Sans
authors.forename: Alejandro
authors.initials: A
authors.lastname: Roca-Cusachs
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Sierra
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications / Q000503:physiopathology / Q000652:urine*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D003404:Creatinine / Q000097:blood; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D013030:Spain / Q000453:epidemiology
chemical_list: D003404:Creatinine
keywords: blood pressure; cardiovascular disease; cardiovascular outcomes; hypertension; microalbuminuria; resistant hypertension; urinary albumin excretion