LONGITUDINAL CHANGE IN RENAL DYSFUNCTION BIOMARKERS PREDICT OUTCOME DIFFERENTLY IN HYPERTENSIVE AND NORMOTENSIVE PERSONS FROM THE GENERAL POPULATION. THE TROMSØ STUDY

• Published in: Journal of Hypertension
• Main Authors: Solbu, Marit Dahl, Melsom, Toralf, Norvik, Jon Viljar, Eriksen, Bjørn Odvar, Eggen, Anne Elise, Løchen, Maja -Lisa, Zykova, Svetlana N., Jenssen, Trond Geir
• Format: Article in Journal/Newspaper
• Language: English
• Published: Ovid Technologies (Wolters Kluwer Health) 2021
• Subjects: Tromsø
• Online Access: http://dx.doi.org/10.1097/01.hjh.0000744492.43820.4e; https://journals.lww.com/10.1097/01.hjh.0000744492.43820.4e

Objective: Serum uric acid (SUA), urinary albumin-creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are associated with hypertension and adverse cardiovascular (CV) outcome. Little is known about outcome after longitudinal changes in these biomarkers. We aimed to assess the associations between seven years’ change in these renal biomarkers and the incidence of CV disease and mortality in hypertensive and normotensive individuals from the general population. Design and method: We included all participants with measurements of SUA, eGFR and ACR in survey 4 (1994/95) and 5 (2001/02) of the Tromsø Study. Hypertension at baseline (1994/95) was defined as systolic blood pressure (BP) > = 140 mmHg, diastolic BP > = 90 mmHg and/or antihypertensive drug use. We used Cox regression to examine the associations between seven years’ > = 25% increase in SUA and/or ACR, and/or annual eGFR decline of > = 3 mL/min/1.73 m2, and myocardial infarction (MI), ischaemic stroke (IS) and all-cause mortality. Multivariable models adjusted for baseline CV risk factors, changes in systolic BP and body mass index were run separately in hypertensive and normotensive subjects Results: Of the 4663 participants included, 59% had hypertension. At baseline, mean age was 58.3 (9.8) years, eGFR 94 (13) mL/min/1.73 m2, SUA 310 (89) μmol/L and median ACR 0.53 (0.36, 0.87) mg/mmol. Between the 2001/02 visit and 31.12.2013, 479 persons suffered from MI, 394 IS and 1296 died. Increase in ACR > = 25% was associated with MI in normotensive (HR 2.09; 95% CI 1.47, 2.98), but not hypertensive subjects. Change in ACR, SUA or eGFR was not associated with IS. All three variables were associated with all-cause mortality in hypertensive, but not normotensive subjects. However, the association between SUA and death was no longer significant when adjusted for ACR and eGFR change. Conclusions: Increasing ACR was a risk factor for MI in normotensives, whereas increasing ACR and rapid eGFR decline predicted mortality in hypertensive ...