Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy |
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Authors: | Flack John M Duncan Karl Ohmit Suzanne E Quah Ruth Liu Xuefeng Ramappa Preeti Norris Sandra Hedquist Lowell Dudley Amanda Nasser Samar A |
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Institution: | Department of Internal Medicine, Wayne State University, Detroit, Michigan 48201, USA. jflack@med.wayne.edu |
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Abstract: | BackgroundAlbuminuria and glomerular filtration rate (GFR), two factors linked to kidney and vascular function, may influence longitudinal blood pressure (BP) responses to complex antihypertensive drug regimens.MethodsWe reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.ResultsMean patient age was 57-years, 89% of patients were African American, and 69% were women. Mean patient systolic/diastolic BP (SBP/DBP) at baseline was 171/98 mmHg while taking an average of 3.3 antihypertensive medications. At baseline, 27% of patients had estimated (e)GFR <60 ml/min/1.732, 28% had micro-albuminuria (30–300 mg/g) and 16% had macro-albuminuria (>300 mg/g). The average longitudinal BP decline over the observation period (mean 7.2 visits) was 25/12 mmHg. In adjusted regression models, macro-albuminuria predicted a 10.3 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 7.9 mmHg lesser longitudinal DBP reduction (p < 0.001); similarly eGFR <60 ml/min/1.732 predicted an 8.4 mmHg lesser longitudinal SBP reduction (p < 0.001) and a 4.5 lesser longitudinal DBP reduction (p < 0.001). Presence of either micro- or macro-albuminuria, or lower eGFR, also significantly delayed the time to attainment of goal BP.ConclusionsThese data suggest that an attenuated decline in BP in drug-treated hypertensives, resulting in higher average BP levels over the long-term, may mediate a portion of the increased risk of cardiovascular-renal disease linked to elevated urinary albumin excretion and reduced eGFR. |
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Keywords: | albuminuria glomerular filtration rate blood pressure antihypertensive drug therapy |
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