Antihypertensive Drug Use and Urinary Albumin Excretion in Non-diabetic Hypertensive Population

Arterial hypertension together with proteinuria is one of the most important factors associated with the progression of both diabetic and nondiabetic chronic kidney disease. Reduction of blood pressure is an efficient way of slowing the progression of this damage whereas antihypertensive drugs vary in their proteinuriaand microalbuminurialowering effects. The objective of the present study was to determine the influence of different antihypertensive drug groups on urinary albumin excretion (UAE) as related to blood pressure in non-diabetic subjects. Subjects (n=39) with chronic renal disease accompanied by mild-to-moderate hypertension and varying degrees of proteinuria were included in the study. Patients were divided into three groups based on UAE values (normoalbuminurics, microalbuminurics and macroalbminurics) and were placed on usual care including nonpharmacological and/or treatment with an antihypertensive drug regime (consisting of one or more out of three different antihypertensive drugs (beta-blocker, ACE inhibitor or calcium-channel blocker) to achieve target blood pressure ≤ 130/85 mmHg. Periodic UAE measurements were performed until regression or significant reduction. A reduction in UAE was observed over time in most patients. However, it reached statistical significance only in the microalbuminuric group (p < 0.01). To further analyze the impact of different antihypertensive drugs on UAE, all patients were stratified into groups depending on the assigned therapy. They were divided into the following 5 groups: 0 – nonpharmacological treatment; 1 – assigned drug group 1; 12 – assigned drug groups 1 and 2; 13 – assigned drug groups 1 and 3; 123 – assigned all 3 drug groups where '1' stood for ACE inhibitors, '2' for beta blockers and '3' for calcium channel blockers. A statistically significant change in mean UAE values at the start and end of the study period in patients assigned to drug groups 12, 13 and 123 was achieved (p<0.05). Also, a statistically significant difference existed in the average reduction of proteinuria under varying antihypertensive drug regimens (p<0.05, ANOVA). Post hoc analyses revealed also a significant difference between groups 0 and 13 (p<0.01, Dunnett T3) as well as groups 1 and 13 (p<0.01, Dunnett T3). In patients with hypertension, changes in UAE depend on the initial UAE values and the type of antihypertensive treatment. ACE inhibitors combined with calcium channel blockers produced higher UAE reduction than other drug groups.