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We reviewed the medical records of 180 consecutive hypertensives (average age5 57.4 years) with at least one follow-up visit receiving care in a small urban, academic hypertension practice. One hundred and nineteen women (66.1%), 61 (33.9%) men, 130 (75.1%) African Americans and 43 (24.9%) whites comprised the study sample. Baseline blood pressure [BP] averaged 166/100 mm Hg while taking an average of 3 antihypertensive medications. Serum creatinine and estimated glomerular filtration rate [EGFR] averaged 1.3 mg/dl and 76.9 ml/min/1.73 m , respectively. Body mass index [BMI] averaged 33.1 kg/m . BP response was the average of systolic or diastolic BP at all follow-up visits minus baseline BP as well as by the percent of individuals achieving goal BP according to JNC VI criteria. JNC VI BP goals were , 125/75 for those with proteinuria. 1 gram/24 hours, 130/85 for persons with diabetes, heart failure and/or renal insufficiency, and , 140/90 mm Hg for all others. Estimated glomerular filtration rate was calculated by the modified Cockroft-Gault equation. Urinary albumin excretion was estimated from a single spot urine albumin/creatinine ratio. Overall BP fell 17/9 mm Hg while taking an average of 3.3 drugs during follow-up. Eighty -two patients (58.6%) attained their respective goal BP at an average of 4.1 follow-up visits. BP response was examined above and below an EGFR cut-point of# 48 ml/min/1.73 m; 77.3% of patients with EGFR . 48 ml/min/1.73 m attained goal BP versus only 21% of persons with EGFR# 48 ml/min/1.73 m. Individuals with EGFR# 48 ml/min/1.73 m compared to those with higher GFR required a greater number of medications (4.3 vs 2.8) and follow-up visits (7.8 vs 4.0 ) to achieve goal BP. After adjustment age, sex, race, and baseline BP, urinary albumin: creatinine ratio (p 50.024) and EGFR (p 50.075) were independent predictors of DBP response. DBP response was positively correlated with EGFR but was inversely associated with urinary albumin:creatinine ratio. Conversely, after identical multivariate adjustment neither EGFR or urine:albumin creatinine ratio independently predicted SBP response. These data suggest that readily available clinical markers of renal function influence DBP response to antihypertensive drug therapy, as well as the intensity of antihypertensive therapy and time required to attain JNC VI BP goals.

american journal of hypertension

The influence of urinary albumin excretion and estimated glomerular filtration rate on blood pressure response in drug-treated hypertensive patients in an academic hypertension clinic