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An Observational Registry to Assess Urinary Albumin Evolution in Saudi Hypertensive Patients with the Current Treatment Local algorithm: Results of the RATIONAL Study

Authors Al Shamiri MQ, Al-Ghamdi SMG, Farahat RM, El Desouki HN, ElNazer MS, Saleh HEDM, Abo El Naga AA, Salih AM, Mahmoud KAA, Ahmad NA

Received 26 September 2019

Accepted for publication 20 March 2020

Published 23 April 2020 Volume 2020:13 Pages 75—83


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Pravin Singhal

Mostafa Qaid Al Shamiri, 1 Saeed MG Al-Ghamdi, 2 Rafif M Farahat, 3 Hosam Nasr El Desouki, 4 Mohammed Saeed ElNazer, 5 Hossam El Deen Moustafa Saleh, 6 Ashraf Abdulghani Abo El Naga, 7 Adil Mohammed Salih, 3 Khedr Abdul Aal Mahmoud, 8 Nasim Ahmad Ahmad 9

1Department of Cardiac Science, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia; 2Department of Internal Medicine, King Abdulaziz Hospital, Jeddah, Saudi Arabia; 3Department of Internal Medicine, Suliman Habib Hospital Saudi Arabia, Riyadh; 4Department of Internal Medicine, United Doctors Hospital, Jeddah, Saudi Arabia; 5Department of Internal Medicine, Riyadh National Hospital, Riyadh, Saudi Arabia; 6Department of Internal Medicine, Mecca Medical Center, Mekkah, Saudi Arabia; 7Department of Internal Medicine, Omar Ajaji PC, Riyadh, Saudi Arabia; 8Department of Internal Medicine, New Jedaani Hospital, Jeddah, Saudi Arabia; 9Department of Internal Medicine, Almana Hospital, Jebail, Saudi Arabia

Correspondence: Mostafa Qaid Al Shamiri
Department of Cardiac Science, Faculty of Medicine, King Saud University, PO Box 7805(38), Riyadh 11472, Saudi Arabia
Tel +966 50 413 5042

Introduction: Hypertension causes microalbuminuria, which if left uncontrolled could progress to kidney damage. Antihypertensive treatment primarily aims at controlling blood pressure (BP), but is also shown to control urine albumin excretion. This renoprotective role of antihypertensive medications consists of halting or reverting albuminuria progression.
Patients and Methods: A national Kingdom of Saudi Arabia (KSA), multicenter, observational, longitudinal study (RATIONAL), evaluated the correlation between BP control and microalbuminuria evolution over 1 year. Adult hypertensive patients with kidney damage were enrolled, after giving written consent.
Results: Of 409 patients, 60% had uncontrolled BP at baseline, down to 34% at 12 months. Over 80% of patients were on mono or double antihypertensive therapy, and angiotensin-receptor blockers (ARB) topped the list of medication classes. Albumin–creatinine ratio (ACR) significantly decreased throughout the study, indicating that BP control is paramount to prevent target organ damage. BP change most strongly correlated with ACR change upon triple therapy (ARB + calcium channel blocker + β-blocker). Importantly, 25% (at 6 months) and 38% (at 12 months) of patients reverted back to normoalbuminuria, mostly upon renin-angiotensin system blockers. Around 80% of study patients had also diabetes, a common condition in KSA, which significantly hindered achievement of normoalbuminuria at 12 months.
Conclusion: A modest but solid correlation between BP control and ACR reduction was identified. Results underline proper BP management in KSA and success of antihypertensive treatment in reverting microalbuminuria or delaying its progress. The study duration might be insufficient to reflect conclusively the beneficial effect of longer-term BP control on microalbuminuria evolution.

Keywords: hypertension, microalbuminuria, diabetes, Saudi Arabia, antihypertensive medication class

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