Urinary Albumin Excretion at Follow-Up Predicts Cardiovascular Outcomes in Subjects With Resistant Hypertension

Oliveras, Anna; Armario, Pedro; Sierra, Cristina; Arroyo, J.; Hernandez-Del-Rey, R.; Vázquez, Susana; Larrousse, María; Sans, Laia; Roca-Cusachs, A.; Sierra, Alejandro de la

doi:10.1093/ajh/hpt074

Cited by 14 publications

(7 citation statements)

References 32 publications

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“…The association between CKD and RH is well established, as both a cause and a consequence of therapeutic failure. Besides, moderately increased albuminuria and a reduction in the GFR36 identify patients with a high cardiovascular risk37 , 38 and albuminuria reduction may be used as a therapeutic goal in these patients 39…”

Section: Discussionmentioning

confidence: 99%

Resistant and refractory hypertension: two sides of the same disease?

2019

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Refractory hypertension (RfH) is an extreme phenotype of resistant hypertension (RH), being considered an uncontrolled blood pressure besides the use of 5 or more antihypertensive medications, including a long-acting thiazide diuretic and a mineralocorticoid antagonist. RH is common, with 10-20% of the general hypertensives, and its associated with renin angiotensin aldosterone system hyperactivity and excess fluid retention. RfH comprises 5-8% of the RH and seems to be influenced by increased sympathetic activity. RH patients are older and more obese than general hypertensives. It is strongly associated with diabetes, obstructive sleep apnea, and hyperaldosteronism status. RfH is more frequent in women, younger patients and Afro-americans compared to RFs. Both are associated with increased albuminuria, left ventricular hypertrophy, chronic kidney diseases, stroke, and cardiovascular diseases. The magnitude of the white-coat effect seems to be higher among RH patients. Intensification of diuretic therapy is indicated in RH, while in RfH, therapy failure imposes new treatment alternatives such as the use of sympatholytic therapies. In conclusion, both RH and RfH constitute challenges in clinical practice and should be addressed as distinct clinical entities by trained professionals who are capable to identify comorbidities and provide specific, diversified, and individualized treatment.

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Section: Discussionmentioning

confidence: 99%

Resistant and refractory hypertension: two sides of the same disease?

2019

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“…Foreign studies [7,8] had confirmed that the endothelial function was impaired, the extracellular matrix changed, the vascular permeability increased and lipid material discharged into the blood vessel walls in patients with MAU. Finally, the occurrence of atherosclerosis and CHD was increased [9]. However, the mechanism that hypertensive patients with MAU increased the risk of CHD is unclear.…”

Section: Discussionmentioning

confidence: 99%

Association of Microalbuminuria and IL-6, ET-1 and NO in Patients with Essential Hypertension

Wang¹

2016

ijSciences

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Objective: Research had shown that hypertension was the main risk factor for coronary heart disease (CHD). Hypertension with microalbuminuria (MAU) is the important mark of target organ damage and endothelial function impaired, and also the independent factor for CHD. This paper aimed to explore the mechanism that patients with hypertension combined MAU increased the risk of CHD by investigating the relationship between MAU and IL-6, ET-1, NO in patients with essential hypertension (EH). Methods: To select 132 patients with essential hypertension who were hospitalized in the affiliated hospital of Qingdao university from October 2014 to July 2015. According to the MAU levels, there were 2 experimental groups in this experiment: MAU positive group (MAU>30 mg/l) and MAU negative group (MAU<30 mg/l). And 50 healthy persons in physical examination center of the same hospital were selected as a normal control group. All patients were performed blood routine, urinary routine, stool routine and biochemical analysis. IL-6 level and ET-1 level were measured by enzyme-linked immunosorbent assay. NO level was determined by nitrate reductase method. Statistical analysis was performed by SPSS version 19.0. Results:The serum IL-6 (103.45±4.89pg/ml), ET-1 (209.62±5.00pg/ml) and systolic blood pressure (174.59±25.75mmHg) levels in MAU positive group were obviously higher than that in the MAU negative group. The difference was statistically significant (P< 0.05). The serum NO level (19.76±2.48umol/l) in MAU positive group was significantly lower than that in the MAU negative group. The difference was statistically significant (P<0.05). The multi-factor regression analysis showed that the IL-6 (B=0.206, p=0.021), ET-1 (B=0.594, p<0.01), were positively correlated to MAU, while NO (B=-0.380, p=0.012) was negatively correlated to MAU. Conclusion:(1) The levels of IL-6 and ET-1 in hypertensive patients with MAU increased significantly, and the NO level decreased.(2) IL-6，ET-1 were positively correlated to MAU, while NO was negatively correlated to MAU. (3) Hypertension with MAU has important clinical significance. It needs more attention and effective management.

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“…A associação entre DRC e HAR é clara, tanto como causa quanto como consequência da resistência ao tratamento. Por sua vez, a redução da taxa de filtração glomerular e a albuminúria moderadamente elevada (AME) identificam pacientes de alto risco CV, 40,41 sendo a diminuição da albuminúria um dos objetivos terapêuticos nesses pacientes. 42 O diagnóstico de HVE pode ser feito por meio do eletrocardiograma (ECG) de repouso, por se tratar de uma ferramenta de baixo custo e bastante disponível em nosso meio.…”

Section: Afastar Pseudorresistênciaunclassified

“…41 Em um estudo realizado com uma coorte de 133 hipertensos resistentes acompanhados por 6 meses, a persistência da AME também se relacionou ao aumento do risco CV. 40 Recentemente, foi demonstrado o valor prognóstico da proteína C-reativa como preditora de doença coronariana e cerebrovascular, em especial na população de hipertensos resistentes mais jovens, obesos com padrão não dipper e MAPA não controlada. 67…”

Section: D) Quarta Drogaunclassified

Hipertensão resistente: abordagem clínica

Muxfeldt

Barreira

Rodrigues

2018

Rev. Fac. Ciênc. Méd. Sorocaba

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Hipertensão arterial resistente é definida como a pressão arterial de consultório não controlada, apesar do uso de três ou mais anti-hipertensivos, incluindo, preferencialmente, um diurético. Indivíduos em uso de quatro ou mais medicamentos com controle pressórico também são considerados hipertensos resistentes. Por sua vez, hipertensão refratária é a pressão arterial não controlada, apesar do uso de cinco ou mais drogas, incluindo um tiazídico de ação prolongada e um antagonista da aldosterona. Sua prevalência vem crescendo com o envelhecimento da população e o avanço da obesidade, estando relacionada às altas taxas de morbidade e mortalidade de origem cardiovascular e renal. A abordagem diagnóstica se baseia em quatro pontos: afastar pseudorresistência, identificar o fenômeno do jaleco branco, investigar causas secundárias e identificar lesões subclínicas para estratificação do risco cardiovascular. O objetivo terapêutico é o controle da pressão arterial de 24 horas. Mudanças de estilo de vida devem ser implementadas e as três primeiras drogas devem incluir um diurético adequado, um inibidor do sistema renina-angiotensina-aldosterona e um bloqueador de canais de cálcio. Persistindo o descontrole pressórico, adicionamos a quarta droga: espironolactona. Quanto aos hipertensos refratários, novas modalidades terapêuticas vêm sendo desenvolvidas, como a denervação renal e a estimulação do barorreflexo.

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Urinary Albumin Excretion at Follow-Up Predicts Cardiovascular Outcomes in Subjects With Resistant Hypertension

Abstract: In RH patients, the inability to microalbuminuria regression, either due to persistence or new appearance, independently predicts CVD.

Cited by 14 publications

References 32 publications

Resistant and refractory hypertension: two sides of the same disease?

Resistant and refractory hypertension: two sides of the same disease?

Association of Microalbuminuria and IL-6, ET-1 and NO in Patients with Essential Hypertension

Hipertensão resistente: abordagem clínica

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