August 10, 2009Current Opinion in Nephrology & Hypertension
Should proteinuria reduction be the criterion for antihypertensive drug selection for patients with kidney disease?
Key result
Reducing proteinuria by ≥30% alongside blood pressure lowering slowed nephropathy progression by an additional 28-39% compared to control groups in retrospective analyses of outcome trials.
Why the study?
Does blood pressure-lowering therapy targeting >30% proteinuria reduction slow nephropathy progression in patients with hypertension and kidney disease or diabetes?
Population
Patients with a history of hypertension and either kidney disease or diabetes, specifically those with…
Comparison
Blood pressure-lowering therapy targeting a… vs Blood pressure-lowering therapy without >30%…
Design
Review
Authors
Discussion
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Implication
Hypothesis-generating for proteinuria targets in hypertensive nephropathy; prospective RCTs needed before practice change.
Key Points
- To evaluate whether achieving at least a 30% reduction in proteinuria alongside blood pressure lowering should guide antihypertensive drug selection in kidney disease.
- Reviewed retrospective analyses from five large nephropathy outcome trials and related cardiovascular outcome trials.
- Evaluated the impact of blood pressure lowering alone versus concurrent blood pressure and proteinuria reduction across microalbuminuria and macroproteinuria (>200 mg/day).
- Retrospective analysis of five large nephropathy trials showed progression slowed by an additional 28% to 39% over control or placebo when proteinuria decreased alongside blood pressure.
- Two trials showed nephropathy progression slowed to a lesser degree when blood pressure was reduced to a similar level but proteinuria decreased by less than 30%.
- Proteinuria reduction was not associated with improved nephropathy outcomes in patients with microalbuminuria, where blood pressure reduction was the primary driver of benefit.
Structured PICO
Does blood pressure-lowering therapy targeting >30% proteinuria reduction slow nephropathy progression in patients with hypertension and kidney disease or diabetes?
P
Population
Patients with a history of hypertension and either kidney disease or diabetes, specifically those with proteinuria (>200 mg/day of urinary albumin).
I
Intervention
Blood pressure-lowering therapy targeting a reduction of >30% of urinary protein.
C
Comparator
Blood pressure-lowering therapy without >30% proteinuria reduction.
O
Outcome
Nephropathy progressionsurrogate
In patients with hypertension and kidney disease or diabetes with proteinuria >200 mg/day, antihypertensive therapy should target a >30% reduction in urinary protein to slow nephropathy progression.
Cite This Study
Kalaitzidis et al. (2009) conducted a review in Kidney disease and hypertension. Blood pressure-lowering therapy with ≥30% proteinuria reduction vs. Blood pressure lowering without ≥30% proteinuria reduction was evaluated on Nephropathy progression. Reducing proteinuria by ≥30% alongside blood pressure lowering slowed nephropathy progression by an additional 28-39% compared to control groups in retrospective analyses of outcome trials.