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Estimated GFR or Albuminuria: Which One Is Really Associated With Resistant Hypertension?

      Summary

      Patients with resistant hypertension belong to a very high cardiovascular risk group and have a high prevalence of target organ damage. Microalbuminuria and low estimated glomerular filtration rate are associated with resistant hypertension, and could be a cause and/or complication of hypertension. In this review, we explore the relationship between these 2 markers of kidney disease and the prevalence of resistant hypertension. We identified different phenotypes of resistant hypertension that associate with microalbuminuria and/or low estimated glomerular filtration rate. These phenotypes suggest that high sympathetic activity associated with fluid overload and endothelial dysfunction may contribute differently to the development of resistant hypertension.

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      References

        • Egan B.M.
        • Zhao Y.
        • Axon RN.
        US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008.
        JAMA. 2010; 303: 2043-2050
        • Olives C.
        • Myerson R.
        • Mokdad A.H.
        • Murray C.J.
        • Lim S.S.
        Prevalence, awareness, treatment, and control of hypertension in United States counties, 2001-2009.
        PLoS One. 2013; 8: e60308
        • Sim J.J.
        • Bhandari S.K.
        • Shi J.
        • et al.
        Characteristics of resistant hypertension in a large, ethnically diverse hypertension population of an Integrated Health System.
        Mayo Clin Proc. 2013; 88: 1099-1107
        • Calhoun D.A.
        • Jones D.
        • Textor S.
        • et al.
        Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research.
        Hypertension. 2008; 51: 1403-1419
        • Sarafidis P.A.
        • Georgianos P.
        • Bakris G.L.
        Resistant hypertension--its identification and epidemiology.
        Nat Rev Nephrol. 2013; 9: 51-58
        • McAdam-Marx C.
        • Ye X.
        • Sung J.C.
        • Brixner D.I.
        • Kahler K.H.
        Results of a retrospective, observational pilot study using electronic medical records to assess the prevalence and characteristics of patients with resistant hypertension in an ambulatory care setting.
        Clin Ther. 2009; 31: 1116-1123
        • de la Sierra A.
        • Segura J.
        • Banegas J.R.
        • et al.
        Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring.
        Hypertension. 2011; 57: 898-902
        • Egan B.M.
        • Zhao Y.
        • Axon R.N.
        • Brzezinski W.A.
        • Ferdinand KC
        Uncontrolled and apparent treatment resistant hypertension in the United States, 1988 to 2008.
        Circulation. 2011; 124: 1046-1058
        • Persell S.D.
        Prevalence of resistant hypertension in the United States, 2003-2008.
        Hypertension. 2011; 57: 1076-1080
        • De Nicola L.
        • Gabbai F.B.
        • Agarwal R.
        • et al.
        Prevalence and prognostic role of resistant hypertension in chronic kidney disease patients.
        J Am Coll Cardiol. 2013; 61: 2461-2467
        • Muxfeldt E.S.
        • Bloch K.V.
        • Nogueira A.R.
        • Salles G.F.
        Twenty-four hour ambulatory blood pressure monitoring pattern of resistant hypertension.
        Blood Press Monit. 2003; 8: 181-185
        • de la Sierra A.
        • Banegas J.R.
        • Oliveras A.
        • et al.
        Clinical differences between resistant hypertensives and patients treated and controlled with three or less drugs.
        J Hypertens. 2012; 30: 1211-1216
        • Salles G.F.
        • Cardoso C.R.
        • Muxfeldt E.S.
        Prognostic influence of office and ambulatory blood pressures in resistant hypertension.
        Arch Intern Med. 2008; 168: 2340-2346
        • Salles G.F.
        • Cardoso C.R.
        • Fiszman R.
        • Muxfeldt E.S.
        Prognostic importance of baseline and serial changes in microalbuminuria in patients with resistant hypertension.
        Atherosclerosis. 2011; 216: 199-204
        • Oliveras A.
        • Armario P.
        • Sierra C.
        • et al.
        Urinary albumin excretion at follow-up predicts cardiovascular outcomes in subjects with resistant hypertension.
        Am J Hypertens. 2013; 26: 1148-1154
        • Muxfeldt E.S.
        • Bloch K.V.
        • Nogueira Ada R.
        • Salles G.F.
        True resistant hypertension: is it possible to be recognized in the office?.
        Am J Hypertens. 2005; 18: 1534-1540
        • Pedrinelli R.
        • Giampietro O.
        • Carmassi F.
        • et al.
        Microalbuminuria and endothelial dysfunction in essential hypertension.
        Lancet. 1994; 344: 14-18
        • Stehouwer C.D.
        • Henry R.M.
        • Dekker J.M.
        • Nijpels G.
        • Heine R.J.
        • Bouter L.M.
        Microalbuminuria is associated with impaired brachial artery, flow-mediated vasodilation in elderly individuals without and with diabetes: further evidence for a link between microalbuminuria and endothelial dysfunction--the Hoorn Study.
        Kidney Int Suppl. 2004; 92: S42-S44
        • Oliveras A.
        • Armario P.
        • Hernandez-Del Rey R.
        • et al.
        Urinary albumin excretion is associated with true resistant hypertension.
        J Hum Hypertens. 2010; 24: 27-33
        • Viberti G.C.
        • Hill R.D.
        • Jarrett R.J.
        • Argyropoulos A.
        • Mahmud U.
        • Keen H.
        Microalbuminuria as a predictor of clinical nephropathy in insulin-dependent diabetes mellitus.
        Lancet. 1982; 1: 1430-1432
        • Cerasola G.
        • Cottone S.
        • Mule G.
        The progressive pathway of microalbuminuria: from early marker of renal damage to strong cardiovascular risk predictor.
        J Hypertens. 2010; 28: 2357-2369
        • Levey A.S.
        • Cattran D.
        • Friedman A.
        • et al.
        Proteinuria as a surrogate outcome in CKD: report of a scientific workshop sponsored by the National Kidney Foundation and the US Food and Drug Administration.
        Am J Kidney Dis. 2009; 54: 205-226
        • Tenten V.
        • Menzel S.
        • Kunter U.
        • et al.
        Albumin is recycled from the primary urine by tubular transcytosis.
        J Am Soc Nephrol. 2013; 24: 1966-1980
        • Rodicio J.L.
        • Campo C.
        • Ruilope L.M.
        Microalbuminuria in essential hypertension.
        Kidney Int Suppl. 1998; 68: S51-S54
        • Palatini P.
        • Graniero G.R.
        • Mormino P.
        • et al.
        Prevalence and clinical correlates of microalbuminuria in stage I hypertension. Results from the Hypertension and Ambulatory Recording Venetia Study (HARVEST Study).
        Am J Hypertens. 1996; 9: 334-341
        • Cirillo M.
        • Stellato D.
        • Laurenzi M.
        • Panarelli W.
        • Zanchetti A.
        • De Santo N.G.
        Pulse pressure and isolated systolic hypertension: association with microalbuminuria. The GUBBIO Study Collaborative Research Group.
        Kidney Int. 2000; 58: 1211-1218
        • Christensen P.K.
        • Hommel E.E.
        • Clausen P.
        • Feldt-Rasmussen B.
        • Parving H.H.
        Impaired autoregulation of the glomerular filtration rate in patients with nondiabetic nephropathies.
        Kidney Int. 1999; 56: 1517-1523
        • Cottone S.
        • Cerasola G.
        Microalbuminuria fractional clearance and early renal permselectivity changes in essential hypertension.
        Am J Nephrol. 1992; 12: 326-329
        • Whaley-Connell A.T.
        • Chowdhury N.A.
        • Hayden M.R.
        • et al.
        Oxidative stress and glomerular filtration barrier injury: role of the renin-angiotensin system in the Ren2 transgenic rat.
        Am J Physiol Renal Physiol. 2006; 291: F1308-F1314
        • Deckert T.
        • Feldt-Rasmussen B.
        • Borch-Johnsen K.
        • Jensen T.
        • Kofoed-Enevoldsen A.
        Albuminuria reflects widespread vascular damage. The Steno hypothesis.
        Diabetologia. 1989; 32: 219-226
        • de Zeeuw D.
        • Parving H.H.
        • Henning R.H.
        Microalbuminuria as an early marker for cardiovascular disease.
        J Am Soc Nephrol. 2006; 17: 2100-2105
        • Palatini P.
        • Mormino P.
        • Mos L.
        • et al.
        Microalbuminuria, renal function and development of sustained hypertension: a longitudinal study in the early stage of hypertension.
        J Hypertens. 2005; 23: 175-182
        • Ogunniyi M.O.
        • Croft J.B.
        • Greenlund K.J.
        • Giles W.H.
        • Mensah G.A.
        Racial/ethnic differences in microalbuminuria among adults with prehypertension and hypertension: National Health and Nutrition Examination Survey (NHANES), 1999-2006.
        Am J Hypertens. 2010; 23: 859-864
        • Nogueira Ada R.
        • Fernandes A.S.
        • Coutinho E.S.
        • Salles G.F.
        • Muxfeld E.S.
        • Bloch K.V.
        Factors associated with microalbuminuria in resistant hypertension.
        Int J Cardiol. 2007; 121: 86-87
        • Salles G.F.
        • Cardoso C.R.
        • Pereira V.S.
        • Fiszman R.
        • Muxfeldt E.S.
        Prognostic significance of a reduced glomerular filtration rate and interaction with microalbuminuria in resistant hypertension: a cohort study.
        J Hypertens. 2011; 29: 2014-2023
        • Kovesdy C.P.
        • Lott E.H.
        • Lu J.L.
        • et al.
        Outcomes associated with microalbuminuria: effect modification by chronic kidney disease.
        J Am Coll Cardiol. 2013; 61: 1626-1633
        • Navarro-Gonzalez J.F.
        • Mora C.
        • Muros M.
        • Jarque A.
        • Herrera H.
        • Garcia J.
        Association of tumor necrosis factor-alpha with early target organ damage in newly diagnosed patients with essential hypertension.
        J Hypertens. 2008; 26: 2168-2175
        • Moubarak M.
        • Jabbour H.
        • Smayra V.
        • et al.
        Cardiorenal syndrome in hypertensive rats: microalbuminuria, inflammation and ventricular hypertrophy.
        Physiol Res. 2012; 61: 13-24
        • Franco M.
        • Tapia E.
        • Bautista R.
        • et al.
        Impaired pressure natriuresis resulting in salt-sensitive hypertension is caused by tubulointerstitial immune cell infiltration in the kidney.
        Am J Physiol Renal Physiol. 2013; 304: F982-F990
        • Peralta C.A.
        • Norris K.C.
        • Li S.
        • et al.
        Blood pressure components and end-stage renal disease in persons with chronic kidney disease: the Kidney Early Evaluation Program (KEEP).
        Arch Intern Med. 2012; 172: 41-47
        • Peixoto A.J.
        • Orias M.
        • Desir G.V.
        Does kidney disease cause hypertension?.
        Curr Hypertens Rep. 2013; 15: 89-94
        • Converse Jr, R.L.
        • Jacobsen T.N.
        • Toto R.D.
        • et al.
        Sympathetic overactivity in patients with chronic renal failure.
        N Engl J Med. 1992; 327: 1912-1918
        • Grassi G.
        • Quarti-Trevano F.
        • Seravalle G.
        • et al.
        Early sympathetic activation in the initial clinical stages of chronic renal failure.
        Hypertension. 2011; 57: 846-851
        • Vink E.E.
        • de Jager R.L.
        • Blankestijn P.J.
        Sympathetic hyperactivity in chronic kidney disease: pathophysiology and (new) treatment options.
        Curr Hypertens Rep. 2013; 15: 95-101
        • Tanner R.M.
        • Calhoun D.A.
        • Bell E.K.
        • et al.
        Prevalence of apparent treatment-resistant hypertension among individuals with CKD.
        Clin J Am Soc Nephrol. 2013; 8: 1583-1590
        • Borrelli S.
        • De Nicola L.
        • Stanzione G.
        • Conte G.
        • Minutolo R.
        Resistant hypertension in nondialysis chronic kidney disease.
        Int J Hypertens. 2013; 2013: 929183
        • Pimenta E.
        • Gaddam K.K.
        • Oparil S.
        • et al.
        Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: results from a randomized trial.
        Hypertension. 2009; 54: 475-481
        • Lamas S.
        • Rodriguez-Puyol D.
        Endothelial control of vasomotor tone: the kidney perspective.
        Semin Nephrol. 2012; 32: 156-166
        • Endemann D.H.
        • Schiffrin E.L.
        Endothelial dysfunction.
        J Am Soc Nephrol. 2004; 15: 1983-1992
        • Feletou M.
        • Vanhoutte P.M.
        Endothelial dysfunction: a multifaceted disorder (The Wiggers Award Lecture).
        Am J Physiol Heart Circ Physiol. 2006; 291 (H985-1002)
        • Schiffrin E.L.
        • Lipman M.L.
        • Mann J.F.
        Chronic kidney disease: effects on the cardiovascular system.
        Circulation. 2007; 116: 85-97
        • Clausen P.
        • Jensen J.S.
        • Jensen G.
        • Borch-Johnsen K.
        • Feldt-Rasmussen B.
        Elevated urinary albumin excretion is associated with impaired arterial dilatory capacity in clinically healthy subjects.
        Circulation. 2001; 103: 1869-1874
        • Lim S.C.
        • Caballero A.E.
        • Smakowski P.
        • LoGerfo F.W.
        • Horton E.S.
        • Veves A.
        Soluble intercellular adhesion molecule, vascular cell adhesion molecule, and impaired microvascular reactivity are early markers of vasculopathy in type 2 diabetic individuals without microalbuminuria.
        Diabetes Care. 1999; 22: 1865-1870
        • Landray M.J.
        • Wheeler D.C.
        • Lip G.Y.
        • et al.
        Inflammation, endothelial dysfunction, and platelet activation in patients with chronic kidney disease: the Chronic Renal Impairment in Birmingham (CRIB) study.
        Am J Kidney Dis. 2004; 43: 244-253
        • Park J.B.
        • Schiffrin E.L.
        Small artery remodeling is the most prevalent (earliest?) form of target organ damage in mild essential hypertension.
        J Hypertens. 2001; 19: 921-930
        • de La Sierra A.
        • Larrousse M.
        • Oliveras A.
        • et al.
        Abnormalities of vascular function in resistant hypertension.
        Blood Press. 2012; 21: 104-109
        • Wassmann S.
        • Laufs U.
        • Baumer A.T.
        • et al.
        HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species.
        Hypertension. 2001; 37: 1450-1457
        • Wassmann S.
        • Laufs U.
        • Stamenkovic D.
        • et al.
        Raloxifene improves endothelial dysfunction in hypertension by reduced oxidative stress and enhanced nitric oxide production.
        Circulation. 2002; 105: 2083-2091
        • Gaddam K.
        • Corros C.
        • Pimenta E.
        • et al.
        Rapid reversal of left ventricular hypertrophy and intracardiac volume overload in patients with resistant hypertension and hyperaldosteronism: a prospective clinical study.
        Hypertension. 2010; 55: 1137-1142