Influence of albuminuria and glomerular filtration rate on blood pressure response to antihypertensive drug therapy

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Authors: John M Flack, Karl Duncan, Suzanne E Ohmit, Ruth Quah, Xuefeng Liu, et al

Published Date January 2007 Volume 2007:3(6) Pages 1029 - 1037

DOI: http://dx.doi.org/10.2147/VHRM.S

John M Flack¹, Karl Duncan², Suzanne E Ohmit³, Ruth Quah¹, Xuefeng Liu¹, Preeti Ramappa¹, Sandra Norris¹, Lowell Hedquist¹, Amanda Dudley¹, Samar A Nasser¹

¹Division of Translational Research and Clinical Epidemiology, Department of Internal Medicine, Wayne State University, Detroit, MI, USA; ²Department of Interventional Cardiology, Harper University Hospital, Detroit Medical Center, Detroit, MI, USA; ³School of Public Health, University of Michigan, Ann Arbor, MI, USA

Background: Albuminuria 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.

Methods: We reviewed the clinic records of 459 patients with hypertension in an urban, academic practice.

Results: Mean 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.

Conclusions: These 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.

Keywords: albuminuria, glomerular filtration rate, blood pressure, antihypertensive drug therapy