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Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study

Journal of Human Hypertension volume 32, pages 139–149 (2018)Cite this article

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Abstract

Moderately increased albuminuria, defined as urinary albumin excretion rate (UAER) between 30 and 300–mg/24–h is a well-known cardiovascular risk factor, especially in diabetic and hypertensive patients. This study aim to analyze the prognostic value of baseline UAER in a still understudied group, patients with resistant hypertension (RHT). This is a prospective observational study, which had enrolled 1048 outpatients with RHT, who were submitted to a clinical-laboratory assessment and ambulatory blood pressure monitoring (ABPM) during the follow-up. Primary endpoints were a composite of fatal and non-fatal cardiovascular events, all-cause mortality and cardiovascular mortality. Survival analysis by multiple Cox regression assessed the associations among endpoints, baseline UAER, glomerular filtration rate (GFR), and ABPM control. After a mean 7.5 years follow-up, 233 patients died, 120 from cardiac death; 215 cardiovascular events occurred, 90 strokes and 116 coronary diseases. UAER above 30–mg/24–h increased above 40% the risk of fatal and non-fatal cardiovascular events, and of all-cause mortality. At these UAER levels, secondary outcomes were associated to increased risk of stroke and risk of end-stage renal disease, but did not affect coronary events. Both the GFR below 60–mL/min and uncontrolled ABPM were related to nearly two-fold raised risk of fatal and non-fatal cardiovascular events, when coupled with UAER above 30–mg/24–h. In conclusion, moderately increased albuminuria predicts cardiovascular events and all-cause mortality in RHT, and its prognostic impact is enhanced in association with a GFR under 60–mL/min and uncontrolled baseline ABPM.

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Acknowledgements

This study was supported by grants from PETROBRAS-FINEP, Conselho Brasileiro de Desenvolvimento Científico e Tecnológico (CNPq), and Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ).

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  1. All authors contributed equally to this work.

Authors and Affiliations

  1. University Hospital Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro, Rua Homem de Melo, 150/102 – CEP 20510-180 - Tijuca, Rio de Janeiro, RJ, Brazil

    Paula Moreira da Costa, Arthur Fernandes Cortez, Fabio de Souza, Gabriel de Souza Mares, Bruno Dussoni Moreira dos Santos & Elizabeth Silaid Muxfeldt

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  1. Paula Moreira da Costa
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  2. Arthur Fernandes Cortez
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Correspondence to Elizabeth Silaid Muxfeldt.

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da Costa, P.M., Cortez, A.F., de Souza, F. et al. Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study. J Hum Hypertens 32, 139–149 (2018). https://doi.org/10.1038/s41371-017-0013-2

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