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Does microalbuminuria predic renal disease in hypertensive african american?
A]H-APRIL 1996-VOL. 9, NO.4, PART 2
POSTERS: Treatment of Hypertension in Special Groups
19
110
DDTI:RENT 'l1URAPD:S IN TREAnmm' OF OBJ:srrY IN HYPJ:RI1:NS'IVJ: P.\1'IENTS. ET MOIleao MRG Peixoto, ~ ~ /ILL SOUII, VLN Bnp, ),IF Moln. Hyperteflllloo LeIlJll'l S~ool of. M;edicine, Nuning md Nutrition, Fedenl Univtrllity of GoI", Golorua - Go • Brazil . ~e obj~ctive of our Itudy il to evalu-te the efficacy md tolerablhty of dIfferent therapiel ,,"oclated to diet in treatment of hypertenolve obele.. Thro\l8h ramdom choice we evalu-ted 39 hypertenllve obelel potlentl (BMI 30K&/M% • men and >-29~2 - women). Before ilolated diet durin& 45 day" they were diotnbl:ted in @l'OIJPI IIId received in double blind way: Group A • hypoclloric diet + placebo; (]roup B - hypocoloric diet + (]roup C -hypocoloric diet + dexfenf)unmine(1 Sma); (opiruline(32Smg)+fUCUI(SOOrnI>+selotine(SOOmg), :z timel day. Followed-up during 12 weeko \lImg drugo IIId 24 more week. without lilY. Evaluated lI&'lllllt.: Weight, Body M... Index(BMI). Blood Prellure(BP) IIId .ide effectl. Twenty leven pllientl completed the ob.tl'Y8tion (8 in group "" II in VOUP B IIId 8 in VOUP C) .
EFFICACY AND TOLERABILITY OF ONCE-DAILY FIXED DOSE COMBINATIONS OF VERAPAMIL + TRANDOLAPRIL IN BLACK HYPERTENSIVE PATIENTS USING AMBULATORY BLOOD PRESSURE ~ONITORING. V. Strugo. I. Radavski. Z Hlatlwavo. f....S.m!l. CardiologV Department. Baragwanath Hospital. Johannesburg. South Africa. Since Black hypertensives constitute a high-risk group (endorgan vulnerabilitv), we tested a potent ACE Inhibitor/calcium blocker combination, using ambulatorv monitoring (Spacelabs 90207) in 21 patients (pts) (age 52 ± 10 years; 10 males, 11 females) with mild-moderate hypertension (mean 12-hour daytime DBP ~ 90mmHg and ~ 114mmHg after a 14-day placebo wash-out. Starting therapy was (1) verapamil + trandolapril 180 + 2mg. Dose was uptltrated monthly if mean daytime DBP remained ~ 90mmHg, to (2) 240 + 4mg, (3) 360 + 4mg and 141 addition of hvdrochlorothiazlde 12.5mg.
w~
I fln~A ~B
~c
2
3
BMI
2
2
2
I2J 112 120 32J 322 326 87" 144 837" 350 33J 336 833 821 83.1 DD 326 330
DBP
SUP
1<1152 1361 1419
un
I~J 1~2
UIA 14S.0 1416
goA IU 914 943 943 891 "2 872 923
I. Itu1Ial 2. U Wilks 3. 36 ..lokI BMI ·Body M... Indez SBP • Srlt.lie Blo.d Pn.1Ul't DBP • DiaoIolic Blood Pn.1Ul't
'P
Iu we .ee 1ft thole from
Key Words:
Obelity, Treatment, Hypertenlion, Blood Prellure
~
~
SBP (mmHgl 150 ± 14 131 .±. 13 [.J DBP (mmHg) 96 + 7 82 + 8 (.) HR (beats/min) 76 :±: 10 69:±: 8 [lJ Dav SBP(mmHg) 154± 12 136± 12 (.) DBP (mmHgl 100 ± 6 87.±. 9 [.) Night SBP (mmHg) 146.±. 16 126.±. 14 [.J DBP (mmHg) 90.±. 9 76.±. 9 [.) (8aseline vs 4 months: # p < 0.02, • p < 0.001) Mean daytime DBP was < 90mmHg at the end of the trial in 12/21 pts. Five pts were controlled on dose (11. 4 on dose (21, 3 on dose (3). 24-hour BP load (% of SBP/DBP readings > 140/90mmHg. daytime and < t 20/80, night) decreased from 72.±. 18% to 35.±. 25% Ip < 0.001). Mean DBP drop was 15mmHg for the forst 18 hours and 11 mmHg for the last 6 hours. No adverse events or biochemical abnormalities were seen during 4 months' therapy. The combinatIon doses we tested showed a sustained and marked antihypertensive effect throughout the 24-hour dosing interval. Moreover, 180 + 2mg seems an appropriate startIng dose in these pts. 24-hour
Key Words: trandolapril. verapamil. hypertension in Blacks. ambulatorv BP monitoring. combination therepv
111
112
DIAGNOSIS AND TREATMENT OF ISOLATED SYSTOLIC HYPERTENSION (ISH) IN THE ELDERLY: RESULTS OF A STUDY FOUR YEARS POST SHEP. G Ramakrishna. C. Schechter, RA Phillips' Hypenension Section, CV Inslilute, Mount Sinai SChool of Medicine, New York, New York. There is limiled data evaluating the impact on clinical practice of the 1991 Syslolic Hypenenslon m the Elderly Program (SHEP) study. To assess present approaches and attlludes 10 ISH, we surveyed 135 phySIcians dunng Ihe spring of 1995. Questionnaires were dislributed at Internal MedIcine and Cardiology Grand Rounds al MI Smai Medical Center, NY, NY The response rate was 63.7% (87 physic13n responses). Nearly 50% of the respondents had read Ihe SHEP articlc and 82.6% had "heard of the study". Approximately 60% believed ISH should be defined in accordance with Ihe SHEP guideline [SBP ~ 160 mmHgand DBP ~ 90 mmHgJ. Of note, about 30% of phYSICians would initiate pharmacological treatment al a SBP ~ 155 mmHg This ts a level of pressure for which no epidemiological dala e~ists to suppon trealmenl. Of the 85% of physicians (n=73) who opted \0 medicate, the patient's age strongly determmed Ihe SBP at whIch pharmacological treatmenl would be mitiated Whercas 66% of physicians would use drug therapy for patients aged 65-74 WIth a SBP of 160 mmHg or less, 54% and 45% of phySIcians would considcr Ihc same for patlenls aged 75-84 and 85+, respectively 38% of physicians chose thillZlde diurelics as sole first line therapy Calcium channel blockers (CCB's) and ACE mhibilors were chosen by 26.8% and 19.7% of physicians, respectlvely. Popular drug regimens were eithcr CCB's or thIazide diuretICS with ACE mhlbltors (16 and 13%. respectively) When compared to younger phYSICians «65 yrs old). older clinicians (65+ yrs old) were more hkely to agree tlmtthe delectlon of ISH was not impon.1nl and thatlrealment of ISH is ineffective In conclusion, our survey shows a defimte consensus ror initiation of pharmacologicallreatmentln elderly patIents with ISH. However, a significanl number of physicians would mitiale therapy at SBP ~ 155 mm Hg, and a clear consensus is slllliackillg regarding thc specific pharmacologicallreatment ofiSH
DOES MICROALBUMINURIA PREDICT RENAL DISEASE IN HYPERTENSIVE AFRICAN AMERICANS?~', JT Cheng·, L. Herbert, H Nurse', D. Dowie, T. Abakporo, HL Anderson, CK Francis•. Harlem Hospital and Columbia University. New York, NY Microalbuminuria (MA) is a reliable predictor oflhe development renal disease in patients with diabetes mellitus. Although its clinical relevance is unknown, MA may also occur in palients with essential hypertenSIon and nonnal renal function. W. investigated the predictive value of MA for clinical renal disease in a prospective study of hypertensive African-American subjects who were followed for up 10 2.5 years Twenty-four hour urine albumin excretion (UAE) was measured by RIA. One hundred and eighty subjects were studied (S9M,12IF) with a mean age of 57±11 years. Subjects with OM, SCr>1.7 mgidL, or dipSlick urine protein~1 + were excluded. Mean UAE was 22± 36 mg (range 0.44-225); UAE> 30 mgig creat was found in 16.5% oflhe subjects. The MA group was older (S5 vs. 61 yrs) and had a significantly higher SBP (144 vs. 154 mmHg, p< 05). There was no difference between groups in DBP, BMI, duration of hypertension, serum crealinine, creatinine clearance, or class of antihypertensive drugs. During the follow-up period, 15 subjects developed hypenensive renal disease (urine protein>300 mgl24h and/or increase in serum creat of 0.5 mgidL), 7 died, snd I had s stroke (Table I). Tlble I, Prevllence of Hypertensive Complicltions
Key Words: ISH, Hypenension, Elderly, SHEP, tre.1tment
Complication
VAE<30 n-150
~!3~30
povllue
Renal Disease
9.9%
13.20/1
ns
Death
3.3%
6.7%
ns
Stroke
0.7%
0
ns
any outcome 13.2% 20010 ns The occurrence of renal disease and total hypenensive complications were in the expected direction with a grealer prevalence in the group with MA. The differences would reach statistical significance with a larger sample or longer follow up. Larger studies with longer follow up are needed.
Key Words:
microalbuminuria. African Americana. disease
renal
173A
POSTERS: Treatment of Hypertension in Special Groups
19
110
DDTI:RENT 'l1URAPD:S IN TREAnmm' OF OBJ:srrY IN HYPJ:RI1:NS'IVJ: P.\1'IENTS. ET MOIleao MRG Peixoto, ~ ~ /ILL SOUII, VLN Bnp, ),IF Moln. Hyperteflllloo LeIlJll'l S~ool of. M;edicine, Nuning md Nutrition, Fedenl Univtrllity of GoI", Golorua - Go • Brazil . ~e obj~ctive of our Itudy il to evalu-te the efficacy md tolerablhty of dIfferent therapiel ,,"oclated to diet in treatment of hypertenolve obele.. Thro\l8h ramdom choice we evalu-ted 39 hypertenllve obelel potlentl (BMI 30K&/M% • men and >-29~2 - women). Before ilolated diet durin& 45 day" they were diotnbl:ted in @l'OIJPI IIId received in double blind way: Group A • hypoclloric diet + placebo; (]roup B - hypocoloric diet + (]roup C -hypocoloric diet + dexfenf)unmine(1 Sma); (opiruline(32Smg)+fUCUI(SOOrnI>+selotine(SOOmg), :z timel day. Followed-up during 12 weeko \lImg drugo IIId 24 more week. without lilY. Evaluated lI&'lllllt.: Weight, Body M... Index(BMI). Blood Prellure(BP) IIId .ide effectl. Twenty leven pllientl completed the ob.tl'Y8tion (8 in group "" II in VOUP B IIId 8 in VOUP C) .
EFFICACY AND TOLERABILITY OF ONCE-DAILY FIXED DOSE COMBINATIONS OF VERAPAMIL + TRANDOLAPRIL IN BLACK HYPERTENSIVE PATIENTS USING AMBULATORY BLOOD PRESSURE ~ONITORING. V. Strugo. I. Radavski. Z Hlatlwavo. f....S.m!l. CardiologV Department. Baragwanath Hospital. Johannesburg. South Africa. Since Black hypertensives constitute a high-risk group (endorgan vulnerabilitv), we tested a potent ACE Inhibitor/calcium blocker combination, using ambulatorv monitoring (Spacelabs 90207) in 21 patients (pts) (age 52 ± 10 years; 10 males, 11 females) with mild-moderate hypertension (mean 12-hour daytime DBP ~ 90mmHg and ~ 114mmHg after a 14-day placebo wash-out. Starting therapy was (1) verapamil + trandolapril 180 + 2mg. Dose was uptltrated monthly if mean daytime DBP remained ~ 90mmHg, to (2) 240 + 4mg, (3) 360 + 4mg and 141 addition of hvdrochlorothiazlde 12.5mg.
w~
I fln~A ~B
~c
2
3
BMI
2
2
2
I2J 112 120 32J 322 326 87" 144 837" 350 33J 336 833 821 83.1 DD 326 330
DBP
SUP
1<1152 1361 1419
un
I~J 1~2
UIA 14S.0 1416
goA IU 914 943 943 891 "2 872 923
I. Itu1Ial 2. U Wilks 3. 36 ..lokI BMI ·Body M... Indez SBP • Srlt.lie Blo.d Pn.1Ul't DBP • DiaoIolic Blood Pn.1Ul't
'P
Iu we .ee 1ft thole from
Key Words:
Obelity, Treatment, Hypertenlion, Blood Prellure
~
~
SBP (mmHgl 150 ± 14 131 .±. 13 [.J DBP (mmHg) 96 + 7 82 + 8 (.) HR (beats/min) 76 :±: 10 69:±: 8 [lJ Dav SBP(mmHg) 154± 12 136± 12 (.) DBP (mmHgl 100 ± 6 87.±. 9 [.) Night SBP (mmHg) 146.±. 16 126.±. 14 [.J DBP (mmHg) 90.±. 9 76.±. 9 [.) (8aseline vs 4 months: # p < 0.02, • p < 0.001) Mean daytime DBP was < 90mmHg at the end of the trial in 12/21 pts. Five pts were controlled on dose (11. 4 on dose (21, 3 on dose (3). 24-hour BP load (% of SBP/DBP readings > 140/90mmHg. daytime and < t 20/80, night) decreased from 72.±. 18% to 35.±. 25% Ip < 0.001). Mean DBP drop was 15mmHg for the forst 18 hours and 11 mmHg for the last 6 hours. No adverse events or biochemical abnormalities were seen during 4 months' therapy. The combinatIon doses we tested showed a sustained and marked antihypertensive effect throughout the 24-hour dosing interval. Moreover, 180 + 2mg seems an appropriate startIng dose in these pts. 24-hour
Key Words: trandolapril. verapamil. hypertension in Blacks. ambulatorv BP monitoring. combination therepv
111
112
DIAGNOSIS AND TREATMENT OF ISOLATED SYSTOLIC HYPERTENSION (ISH) IN THE ELDERLY: RESULTS OF A STUDY FOUR YEARS POST SHEP. G Ramakrishna. C. Schechter, RA Phillips' Hypenension Section, CV Inslilute, Mount Sinai SChool of Medicine, New York, New York. There is limiled data evaluating the impact on clinical practice of the 1991 Syslolic Hypenenslon m the Elderly Program (SHEP) study. To assess present approaches and attlludes 10 ISH, we surveyed 135 phySIcians dunng Ihe spring of 1995. Questionnaires were dislributed at Internal MedIcine and Cardiology Grand Rounds al MI Smai Medical Center, NY, NY The response rate was 63.7% (87 physic13n responses). Nearly 50% of the respondents had read Ihe SHEP articlc and 82.6% had "heard of the study". Approximately 60% believed ISH should be defined in accordance with Ihe SHEP guideline [SBP ~ 160 mmHgand DBP ~ 90 mmHgJ. Of note, about 30% of phYSICians would initiate pharmacological treatment al a SBP ~ 155 mmHg This ts a level of pressure for which no epidemiological dala e~ists to suppon trealmenl. Of the 85% of physicians (n=73) who opted \0 medicate, the patient's age strongly determmed Ihe SBP at whIch pharmacological treatmenl would be mitiated Whercas 66% of physicians would use drug therapy for patients aged 65-74 WIth a SBP of 160 mmHg or less, 54% and 45% of phySIcians would considcr Ihc same for patlenls aged 75-84 and 85+, respectively 38% of physicians chose thillZlde diurelics as sole first line therapy Calcium channel blockers (CCB's) and ACE mhibilors were chosen by 26.8% and 19.7% of physicians, respectlvely. Popular drug regimens were eithcr CCB's or thIazide diuretICS with ACE mhlbltors (16 and 13%. respectively) When compared to younger phYSICians «65 yrs old). older clinicians (65+ yrs old) were more hkely to agree tlmtthe delectlon of ISH was not impon.1nl and thatlrealment of ISH is ineffective In conclusion, our survey shows a defimte consensus ror initiation of pharmacologicallreatmentln elderly patIents with ISH. However, a significanl number of physicians would mitiale therapy at SBP ~ 155 mm Hg, and a clear consensus is slllliackillg regarding thc specific pharmacologicallreatment ofiSH
DOES MICROALBUMINURIA PREDICT RENAL DISEASE IN HYPERTENSIVE AFRICAN AMERICANS?~', JT Cheng·, L. Herbert, H Nurse', D. Dowie, T. Abakporo, HL Anderson, CK Francis•. Harlem Hospital and Columbia University. New York, NY Microalbuminuria (MA) is a reliable predictor oflhe development renal disease in patients with diabetes mellitus. Although its clinical relevance is unknown, MA may also occur in palients with essential hypertenSIon and nonnal renal function. W. investigated the predictive value of MA for clinical renal disease in a prospective study of hypertensive African-American subjects who were followed for up 10 2.5 years Twenty-four hour urine albumin excretion (UAE) was measured by RIA. One hundred and eighty subjects were studied (S9M,12IF) with a mean age of 57±11 years. Subjects with OM, SCr>1.7 mgidL, or dipSlick urine protein~1 + were excluded. Mean UAE was 22± 36 mg (range 0.44-225); UAE> 30 mgig creat was found in 16.5% oflhe subjects. The MA group was older (S5 vs. 61 yrs) and had a significantly higher SBP (144 vs. 154 mmHg, p< 05). There was no difference between groups in DBP, BMI, duration of hypertension, serum crealinine, creatinine clearance, or class of antihypertensive drugs. During the follow-up period, 15 subjects developed hypenensive renal disease (urine protein>300 mgl24h and/or increase in serum creat of 0.5 mgidL), 7 died, snd I had s stroke (Table I). Tlble I, Prevllence of Hypertensive Complicltions
Key Words: ISH, Hypenension, Elderly, SHEP, tre.1tment
Complication
VAE<30 n-150
~!3~30
povllue
Renal Disease
9.9%
13.20/1
ns
Death
3.3%
6.7%
ns
Stroke
0.7%
0
ns
any outcome 13.2% 20010 ns The occurrence of renal disease and total hypenensive complications were in the expected direction with a grealer prevalence in the group with MA. The differences would reach statistical significance with a larger sample or longer follow up. Larger studies with longer follow up are needed.
Key Words:
microalbuminuria. African Americana. disease
renal
173A