title: Prognostic value of microalbuminuria during antihypertensive treatment in essential hypertension.
abstract: Whether changes over time of urinary albumin excretion have prognostic value is a matter of discussion. The objective was to assess the prognostic value of changes in urinary albumin excretion over time in cardiovascular risk during antihypertensive treatment. Follow-up study of 2835 hypertensives in the absence of previous cardiovascular disease (mean age 55 years, 47% men, BP 138/80 mm Hg, 19.1% diabetics, and calibrated systemic coronary risk estimation 5 or >10.6%). Usual-care of antihypertensive treatment was implemented to maintain blood pressure<140/90 mm Hg. Urinary albumin excretion was assessed yearly, and the values were expressed as the creatinine ratio. Incidence of cardiovascular events, fatal and nonfatal, was recorded during the follow-up. During a median follow-up of 4.7 years (17 028 patients-year), 294 fatal and first nonfatal cardiovascular events were recorded (1.73 CVD per 100 patients/year). Independently of blood pressure, estimated glomerular filtration rate, level of cardiovascular risk, and antihypertensive treatment, microalbuminuria at baseline and at any time during the follow-up resulted in higher risk for events, hazard ratio (HR) 1.35 (95% confidence interval [CI], 1.08-1.79) and HR 1.49 (95% CI, 1.14-1.94), respectively. Likewise, development of microalbuminuria (HR 1.60; 95% CI, 1.04-2.46) or persistence from the beginning (1.53; 95% CI, 1.13-2.06) had a significantly higher rate of events than if remained normoalbuminuric (HR 1) or regress to normoalbuminuria (HR 1.37; 95% CI, 0.92-2.06) with an 18%, 18%, 8%, and 11% events, respectively, P<0.001. The study supports the value of urinary albumin excretion assessment as a prognostic factor for cardiovascular risk, but also opens the way to consider it as an intermediate objective in hypertension.
authors.affiliation: From the Hypertension Clinic, Sagunto Hospital, Valencia, Spain (J.M.P., E.R., J.A.C., M.G.-E., C.G.); CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain (J.M.P., J.R.); and Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA, University of Valencia, Spain (J.R.). pascual_jma@gva.es.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Pascual
authors.affiliation: From the Hypertension Clinic, Sagunto Hospital, Valencia, Spain (J.M.P., E.R., J.A.C., M.G.-E., C.G.); CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain (J.M.P., J.R.); and Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA, University of Valencia, Spain (J.R.).
authors.forename: Enrique
authors.initials: E
authors.lastname: Rodilla
authors.affiliation: From the Hypertension Clinic, Sagunto Hospital, Valencia, Spain (J.M.P., E.R., J.A.C., M.G.-E., C.G.); CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain (J.M.P., J.R.); and Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA, University of Valencia, Spain (J.R.).
authors.forename: Jose Antonio
authors.initials: JA
authors.lastname: Costa
authors.affiliation: From the Hypertension Clinic, Sagunto Hospital, Valencia, Spain (J.M.P., E.R., J.A.C., M.G.-E., C.G.); CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain (J.M.P., J.R.); and Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA, University of Valencia, Spain (J.R.).
authors.forename: Miguel
authors.initials: M
authors.lastname: Garcia-Escrich
authors.affiliation: From the Hypertension Clinic, Sagunto Hospital, Valencia, Spain (J.M.P., E.R., J.A.C., M.G.-E., C.G.); CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain (J.M.P., J.R.); and Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA, University of Valencia, Spain (J.R.).
authors.forename: Carmen
authors.initials: C
authors.lastname: Gonzalez
authors.affiliation: From the Hypertension Clinic, Sagunto Hospital, Valencia, Spain (J.M.P., E.R., J.A.C., M.G.-E., C.G.); CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Madrid, Spain (J.M.P., J.R.); and Hypertension Clinic, Hospital Clinico, Research Institute INCLIVA, University of Valencia, Spain (J.R.).
authors.forename: Josep
authors.initials: J
authors.lastname: Redon
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood / Q000652:urine; D001794:Blood Pressure; D001795:Blood Pressure Determination; D003404:Creatinine / Q000097:blood; D000075222:Essential Hypertension; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D003404:Creatinine
keywords: SCORE; cardiovascular events; hypertension; renal function