Follow‐Up of Cardiovascular Risk Markers in Hypertensive Patients Treated With Irbesartan: Results of the i‐SEARCH Plus Registry

Abstract

Microalbuminuria (MAU), high-sensitivity C-reactive protein (hsCRP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) are risk markers used to predict the prognosis of hypertensive patients; however, they have not been prospectively evaluated in primary care. An investigation was conducted using i-SEARCH Plus, a registry documenting 1649 patients with hypertension who received irbesartan at officebased cardiologists over 12 months. Mean age at baseline was 61.4AE11.3 years, 43.2% were women, and blood pressure was 159.8AE20.1 ⁄ 93.4AE11.9 mm Hg. Median albumin ⁄ creatinine ratio (ACR) at baseline was 9.90 (interquartile range [IQR], 5.76-25.52) mg ⁄ g, hsCRP 2.46 (IQR, 1.16-5.14) mg ⁄ L, and NT-proBNP 89.28 (IQR,) pg ⁄ mL. In patients with MAU (ACR !20 mg ⁄ g), the age-adjusted risk of a combined end point of newly diagnosed coronary artery disease (CAD), myocardial infarction, stroke ⁄ transitory ischemic attack, and death at 12-month follow-up was increased (odds ratio [OR], 2.67; 95% confidence interval [CI], 1.49-4.76), as was the incidence of CAD (OR, 3.27; 95%CI, 1.39-7.68) and death (OR, 4.63; 95%CI,. No correlations with end points were found for hsCRP or NT-proBNP after adjusting for age and the presence of MAU. MAU is an independent predictor of cardiovascular events in hypertensive patients. These findings confirm previous reports on the prognostic value of MAU and establish its incremental value over hsCRP and NT-proBNP. J Clin Hypertens (Greenwich). 2010;12:909-916. R isk markers for future cardiovascular (CV) events gain importance in cases in which the absolute risk is low and the incremental efficacy of new therapeutic options is not dramatic. Hypertension in particular is a disease that gradually develops even at younger ages when CV events are infrequent. The determination of significant differences between drugs and drug classes in this patient population would require large

The role of urinary albumin-to-creatinine ratio as a biomarker to predict stroke

“…7 articles were finally retained [ Figure 1 ]. [ 7 8 14 15 16 17 18 ] The characteristics of the included studies are shown in Table 1 . A total of 159,302 subjects were enrolled in the included studies.…”

“…Whereas, other studies recruited patients with Type 2 DM (T2DM)[ 15 17 ] and patients with hypertension. [ 18 ] A subgroup analysis using random effect model revealed that high UACR was unable to predict stroke in patients with T2DM [ Figure 4a , Random model: HR, 2.25; 95% CI: 0.55–9.17; P = 0.26]. However, analysis using fixed effect model showed that high UACR predicted higher risk of stroke in T2DM patients [ Figure 4b , Fixed model: HR, 1.62; 95% CI: 1.31–1.99; P < 0.01].…”

“…In studies by Bello et al . [ 16 ] and Tebbe et al .,[ 18 ] end point events were defined as transient ischemic attack[ 38 ] and stroke. However, other studies defined only stroke as the end point event.…”

“…[ 13 ] Many studies have demonstrated that high UACR predicts higher risk of stroke, while others argued that UACR is irrelevant to stroke. [ 7 8 10 14 15 16 17 18 ] In this meta-analysis and systemic review, we aimed to summarize all the current results regarding the relationship between UACR and stroke, and investigate whether high UACR predicts higher risk of stroke.…”