Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients -: Losartan intervention for endpoint reduction in hypertension study

被引:452
作者
Ibsen, H [1 ]
Olsen, MH
Wachtell, K
Borch-Johnsen, K
Lindholm, LH
Mogensen, CE
Dahlöf, B
Devereux, RB
de Faire, U
Fyhrquist, F
Julius, S
Kjeldsen, SE
Lederballe-Pedersen, O
Nieminen, MS
Omvik, P
Oparil, S
Wan, Y
机构
[1] Univ Copenhagen, Glostrup Hosp, Med Dept M, DK-2600 Glostrup, Denmark
[2] Steno Diabet Ctr, DK-2820 Gentofte, Denmark
[3] Umea Univ Hosp, S-90185 Umea, Sweden
[4] Arhus Univ Hosp, Aarhus, Denmark
[5] Sahlgrenska Univ Hosp Ostra, Gothenburg, Sweden
[6] Cornell Univ, Weill Med Coll, New York, NY USA
[7] Karolinska Univ Hosp, Stockholm, Sweden
[8] Helsinki Univ Hosp, Helsinki, Finland
[9] Univ Michigan, Ann Arbor, MI USA
[10] Ullevaal Univ Hosp, Oslo, Norway
[11] Viborg Hosp, Viborg, Denmark
[12] Haukeland Univ Hosp, Bergen, Norway
[13] Univ Alabama, Birmingham, AL USA
[14] Merck Res Labs, W Point, PA USA
关键词
albuminuria; angiotensin antagonist; blood pressure; cardiovascular diseases;
D O I
10.1161/01.HYP.0000154082.72286.2a
中图分类号
R6 [外科学];
学科分类号
1002 ; 100210 ;
摘要
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.
引用
收藏
页码:198 / 202
页数:5
相关论文
共 19 条
  • [1] Left ventricular mass assessed by electrocardiography and albumin excretion rate as a continuum in untreated essential hypertension
    Bulatov, VA
    Stenehjem, A
    Os, I
    [J]. JOURNAL OF HYPERTENSION, 2001, 19 (08) : 1473 - 1478
  • [2] Clausen P, 2001, CIRCULATION, V103, P1869
  • [3] Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE):: a randomised trial against atenolol
    Dahlöf, B
    Devereux, RB
    Kjeldsen, SE
    Julius, S
    Beevers, G
    de Faire, U
    Fyhrquist, F
    Ibsen, H
    Kristiansson, K
    Lederballe-Pedersen, O
    Lindholm, LH
    Nieminen, MS
    Omvik, P
    Oparil, S
    Wedel, H
    [J]. LANCET, 2002, 359 (9311) : 995 - 1003
  • [4] Renoprotective therapy: titration against urinary protein excretion
    De Jong, PE
    Navis, G
    de Zeeuw, D
    [J]. LANCET, 1999, 354 (9176) : 352 - 353
  • [5] Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy
    de Zeeuw, D
    Remuzzi, G
    Parving, HH
    Keane, WF
    Zhang, ZX
    Shahinfar, S
    Snapinn, S
    Cooper, ME
    Mitch, WE
    Brenner, BM
    [J]. CIRCULATION, 2004, 110 (08) : 921 - 927
  • [6] Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL
    de Zeeuw, D
    Remuzzi, G
    Parving, HH
    Keane, WF
    Zhang, ZX
    Shahinfar, S
    Snapinn, S
    Cooper, MF
    Mitch, WE
    Brenner, BM
    [J]. KIDNEY INTERNATIONAL, 2004, 65 (06) : 2309 - 2320
  • [7] COMPARISON OF OVERNIGHT, MORNING AND 24-HOUR URINE COLLECTIONS IN THE ASSESSMENT OF DIABETIC MICROALBUMINURIA
    ESHOJ, O
    FELDTRASMUSSEN, B
    LARSEN, ML
    MOGENSEN, EF
    [J]. DIABETIC MEDICINE, 1987, 4 (06) : 531 - 533
  • [8] Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population
    Hillege, HL
    Fidler, V
    Diercks, GFH
    van Gilst, WH
    de Zeeuw, D
    van Veldhuisen, DJ
    Gans, ROB
    Janssen, WMT
    Grobbee, DE
    de Jong, PE
    [J]. CIRCULATION, 2002, 106 (14) : 1777 - 1782
  • [9] Does albuminuria predict cardiovascular outcome on treatment with losartan versus atenolol in hypertension with left ventricular hypertrophy?: A LIFE substudy
    Ibsen, H
    Wachtell, K
    Olsen, MH
    Borch-Johnsen, K
    Lindholm, LH
    Mogensen, CE
    Dahlöf, B
    Devereux, RB
    de Faire, U
    Fyhrquist, F
    Julius, S
    Kjeldsen, SE
    Lederballe-Pedersen, O
    Nieminen, MS
    Omvik, P
    Oparil, S
    Wan, Y
    [J]. JOURNAL OF HYPERTENSION, 2004, 22 (09) : 1805 - 1811
  • [10] Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects -: Five-year follow-up of the Hoorn study
    Jager, A
    Kostense, PJ
    Ruhé, HG
    Heine, RJ
    Nijpels, G
    Dekker, JM
    Bouter, LM
    Stehouwer, CDA
    [J]. ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 1999, 19 (03) : 617 - 624