December 10, 2011Journal of Hypertension
A reappraisal of renin–angiotensin system blockade on microalbuminuria development
Key result
In patients with primary hypertension treated with maximal doses of RAS blockade, 16.1% developed new-onset microalbuminuria and 1.0% developed macroalbuminuria over 3 years.
Population
1433 patients with primary hypertension presenting for the first time to a hospital-based Hypertension Unit
Design
Editorial
Follow-up
3 years
Authors
Discussion
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Implication
The development of microalbuminuria in hypertensive patients on maximal RAS blockade may indicate vascular inflammation rather than progressive kidney disease, suggesting RAS blockers do not uniquely prevent early nephropathy.
Structured PICO
P
Population
1,433 patients with primary hypertension treated with RAS blockade for more than 2 years, followed for 3 years to assess new-onset microalbuminuria.
E
Exposure
Highest available dose of an angiotensin-converting enzyme inhibitor (ACEI) (47% of patients) or an angiotensin-receptor-blocker (ARB) (53%), with a diuretic or calcium channel blocker added if blood pressure remained above 140/90 mmHg
O
Outcome
New-onset microalbuminuria, confirmed on at least two occasions over 6-monthly urine albumin determinations or macroalbuminuria at the last measurementsurrogate
The development of microalbuminuria in hypertensive patients on maximal RAS blockade may indicate vascular inflammation rather than progressive kidney disease, suggesting RAS blockers do not uniquely prevent early nephropathy.
Limitations
- Retrospective nature
- Selected cohort
- Absence of a control group
- Failure to report whether original evaluation of urine albumin excretion was performed more than once
- No other markers of inflammation were recorded
- Dietary sodium consumption was not assessed
- retrospective nature
- selected cohort
- absence of a control group
- failure to report whether the original evaluation of urine albumin excretion was performed more than once
- dietary sodium consumption was not assessed
Cite This Study
Sarafidis et al. (2011) conducted an editorial in Primary hypertension (n=1,433). Renin-angiotensin system (RAS) blockade was evaluated on New-onset microalbuminuria, confirmed on at least two occasions over 6-monthly urine albumin determinations, or macroalbuminuria at the last measurement. In patients with primary hypertension treated with maximal doses of RAS blockade, 16.1% developed new-onset microalbuminuria and 1.0% developed macroalbuminuria over 3 years.