title: The Effect of Resting Heart Rate on the New Onset of Microalbuminuria in Patients With Type 2 Diabetes: A Subanalysis of the ROADMAP Study.
abstract: The association between resting heart rate and new-onset microalbuminuria in patients with type 2 diabetes is not clear. The objective of the current analysis was to assess the relationship between heart rate and incidence of microalbuminuria in patients with type 2 diabetes. Data from the Randomised Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) study were retrospectively analyzed. New-onset microalbuminuria was documented and related to heart rate as recorded at baseline and last assessment, and the mean of the measurements taken during the double-blind part of the ROADMAP trial. Patients (n = 4299) had a mean age of 57.8 ± 8.7 years and 46.3% were male. Characteristics were not different between the olmesartan and the placebo groups, except for a higher systolic blood pressure (136.7 vs 135.7 mm Hg; P = 0.04) and albumin creatinine ratio (5.9 vs 5.5; P = 0.03). Increased risk of microalbuminuria was found with increasing heart rate, independent of whether baseline [highest vs lowest quartile odds ratio (OR) 1.39; 95% confidence interval (95% CI) 1.03-1.87; P = 0.032], last assessment (OR 1.71; 95% CI 1.26-2.31; P = 0.001), or mean heart rate was considered (OR: 1.77; 95% CI: 1.30-2.41; P = 0.0003). The greater risk of new-onset microalbuminuria with a high baseline heart rate was also found when data were adjusted for mean systolic blood pressure (OR: 1.35; 95% CI: 1.00-1.82; P = 0.0496; interaction P < 0.0001). Although there was no risk increase with baseline heart rate in the placebo group (P = 0.8253 for trend), microalbuminuria was less frequent in patients receiving olmesartan in the low heart rate quartiles (P = 0.002 for trend). A low heart rate reduces the risk of patients with type 2 diabetes developing microalbuminuria, independent of blood pressure. The data demonstrate potential benefits of reducing the heart rate of type 2 diabetes patients, and indicate that olmesartan could, in particular, reduce the risk of microalbuminuria in patients with low heart rate.
authors.affiliation: From the Department of Nephrology and Hypertension (RES), University Hospital, Erlangen; Institute for Pharmacology and Preventive Medicine, (PB), Mahlow; Department of Nephrology and Hypertension, Hannover Medical School (HH), Hannover; Institute of Investigation and Hypertension Unit (LMR), Hospital 12 de Octubre, Madrid, Spain; and Department for Internal Medicine III (MB), Saarland University Medical Center, Homburg, Germany.
authors.forename: Roland E
authors.initials: RE
authors.lastname: Schmieder
authors.forename: Peter
authors.initials: P
authors.lastname: Bramlage
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Luis M
authors.initials: LM
authors.lastname: Ruilope
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D004311:Double-Blind Method; D005260:Female; D006339:Heart Rate; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D013777:Tetrazoles / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D007093:Imidazoles; D013777:Tetrazoles; C437965:olmesartan