Reduction in Albuminuria Translates to Reduction in Cardiovascular Events in Hypertensive Patients

Abstract

Abstract-Few data are available to clarify whether changes in albuminuria over time translate to changes in cardiovascular risk.The aim of the present study was to examine whether changes in albuminuria during 4.8 years of antihypertensive treatment were related to changes in risk in 8206 patients with hypertension and left ventricular hypertrophy in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study. Urinary albumin/creatinine ratio (UACR) was measured at baseline and annually. Time-varying albuminuria was closely related to risk for the primary composite end point (ie, when UACR decreased during treatment, risk was reduced accordingly). When the population was divided according to median baseline value (1.21 mg/mmol) and median year 1 UACR (0.67 mg/mmol), risk increased stepwise and significantly for the primary composite end point from those with low baseline/low year 1 (5.5%), to low baseline/high year 1 (8.6%), to high baseline/low year 1 (9.4%), and to high baseline/high year 1 (13.5%) values. Similar significant, stepwise increases in risk were seen for the components of the primary composite end point (cardiovascular mortality, stroke, and myocardial infarction). The observation that changes in UACR during antihypertensive treatment over time translated to changes in risk for cardiovascular morbidity and mortality was not explained by in-treatment level of blood pressure. We propose that monitoring of albuminuria should be an integrated part of the management of hypertension. If albuminuria is not decreased by the patient's current antihypertensive and other treatment, further intervention directed toward blood pressure control and other modifiable risks should be considered. Key Words: albuminuria Ⅲ angiotensin antagonist Ⅲ blood pressure Ⅲ cardiovascular diseases A ssessment of small amounts of urinary albumin excretion, so-called microalbuminuria, has become an integrated marker of cardiovascular risk in diabetic as well as nondiabetic populations. [1][2][3][4] We published data recently from a large group of patients with essential hypertension and ECG-verified left ventricular hypertrophy (LVH) from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study showing a 4-to 5-fold increase in risk for cardiovascular events from the lowest to the highest decile of baseline urinary albumin excretion rate. 3 In another publication from the same hypertensive population, we showed that high urinary albumin excretion rate was related to LVH and was independent of age, blood pressure, diabetes, race, serum creatinine, or smoking. 5 This suggested cardiac organ damage was paralleling increased renal albumin excretion rate, which itself was most likely a marker of generalized hypertensionrelated damage to the peripheral vasculature. 6,7 Although baseline level of urinary albumin excretion is a powerful risk predictor, there are no data from a comprehensive study population to clarify whether a reduction in albuminuria during antihypertensive treatment relates to a ...

Factors associated with brachial-ankle pulse wave velocity in the general population

“…19,20 In addition, reduction of albuminuria under antihypertensive treatment is paralleled by changes in coronary vascular risk. 21,22 Strikingly, salt intake adjusted for body weight was also a significant independent predictor of the baPWV value. Excess salt intake may accelerate atherosclerotic changes independently of its effects on blood pressure.…”

Evidence for renoprotection by blockade of the renin–angiotensin–aldosterone system in hypertension and diabetes

“…72 Results from the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study 73 and from IDNT 62 suggest that a reduction in albuminuria during antihypertensive treatment is associated with a reduction in the risk of cardiovascular events as well as reduction in progression of nephropathy and development of ESRD.…”

Rationale and design of a study to evaluate management of proteinuria in patients at high risk for vascular events: the IMPROVE trial

“…12 However, when kidney disease in hypertensive patients is effectively treated, outcomes improve: post hoc analyses of both HOPE and the LIFE study showed that a reduction of urinary albumin excretion levels was correlated with a decrease in the number of cardiovascular events and death. 12,13 As summarized in Table 1, the ability of reninangiotensin-aldosterone system (RAAS)-blocking interventions to slow progression of advanced kidney disease in hypertensive patients with proteinuria is well established. 14 Moreover, in post hoc analyses of three separate studies, the magnitude of change in proteinuria at 6 months determined renal outcome at 3-5 years; an effect that could not be explained by changes in blood pressure alone.…”