Summary
Within hypertensive populations, the risk of future cardiovascular complications and of death varies substantially according to the risk factor profile of the hypertensive subject. In primary hypertension, significant renal insufficiency is rarely observed, whereas proteinuria can be observed at various frequencies according to the method of analysis and severity of hypertension.
The incidence of clinically apparent proteinuria varies between 4 and 16% in different hypertensive patient series. One prospective observational, epidemiological study has clearly shown that proteinuria is an important, independent predictor of both mortality and cardiovascular morbidity in an untreated population. Two large studies of hypertensive populations treated for 4 and 10 years, respectively, have shown that clinically apparent proteinuria remains as an independent predictor of death and cardiovascular morbidity in treated patients. A third long term study suggests that ‘microalbuminuria’ (i.e. subclinical urinary albumin excretion), if present at start of therapy, also has an important prognostic meaning during long term follow-up. However, it is not yet known whether a reduction and normalisation of the urinary excretion of albumin during long term treatment will also be associated with an improved prognosis.
Similar content being viewed by others
References
Alderman MH, Madhavan S. Management of the hypertensive patient: a continuing dilemma. Hypertension 3: 192–197, 1981
Bauer JH, Gaddy P. Effects of enalapril alone, and in combination with hydrochlorothiazide, on renin-angiotensin-aldosterone, renal function, salt and water excretion, and body fluid composition. American Journal of Kidney Diseases 6: 222–232, 1985
Berglund G. Effects of antihypertensive treatment on prognosis. Hypertension 6 (Suppl. III): 174–178, 1984
Bulpitt CJ, Beilin LJ, Clifton P, Coles EC, Dollery CT, et al. Risk factors for death in treated hypertensive patients. Report from the DHSS Hypertension Care Computing Project. Lancet 2: 134–137, 1979
Bulpitt CJ, Beevers DG, Butler A, Coles EC, Hunt D, et al. The survival of treated hypertensive patients and their causes of death: a report from the DHSS Hypertensive Care Computing Project (DHCCP). Journal of Hypertension 4: 93–99, 1986
De Venuto G, Andreotti C, Mattarei M, Pegoretti G. Long-term captopril therapy at low doses reduces albumin excretion in patients with essential hypertension and no sign of renal impairment. Journal of Hypertension 3 (Suppl. 2): 143–145, 1985
Dunn FG, Oigman W, Ventura HO, Messerli FH, Kobrin I, et al. Enalapril improves systemic and renal hemodynamics and allows regression of left ventricular mass in essential hypertension. American Journal of Cardiology 53: 105–108, 1984
Hall JE, Mizelle HL. The renin-angiotensin system and long term regulation of arterial pressure. Journal of Hypertension 4: 387–397, 1986
Hypertension, Detection and Follow-up Program Cooperative Group. Results and implications of the Hypertension, Detection, and Follow-up Program. Progress in Cardiovascular Disease 1 (Suppl.): 1–88, 1986
Kannel WB, Sorlie P. Hypertension in Framingham. In Paul (Ed.) Epidemiology and control of hypertension, pp. 555–590, Stratton Intercontinental Medical Book Corporation, New York, 1975
Kannel WB, Stampfer MJ, Castelli WP, Vester J. The prognostic significance of proteinuria: The Framinghamn Study. American Heart Journal 108: 1347–1352, 1984
Lewin A, Blaufox D, Castle H, Entwisle G, Langford H. Apparent prevalence of curable hypertension in the Hypertension Detection and Follow-up Program. Archives of Internal Medicine 145: 424–427, 1985
Ljungman S. Renal function, sodium excretion, and the reninangiotensin-aldosterone system in relation to blood pressure. Acta Medica Scandinavica Suppl. 663: 1–68, 1982
Ljungman S, Hartford M, Aurell M, Wikstrand J, Lindstedt G, et al. Does urinary albumin excretion predict cardiovascular disease? Abstract, Third European Meeting on Hypertension, Milan June 14–17, 1987
MacMahon SW, Cutler JA, Furberg CD, Payne GH. The effects of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomized controlled trials. Progress in Cardiovascular Diseases 29 (Suppl. 1): 99–118, 1986
Madhaven S, Alderman MH. The potential effect of blood pressure reduction on cardiovascular disease. Archives of Internal Medicine 141: 1583–1586, 1981
Medical Research Council Working Party. MRC trial of treatment of mild hypertension: principal results. British Medical Journal 291: 97–104, 1985
Mogensen CE, Christensen CK, Christensen NJ, Gundersen HJ, Jacobsen FK, et al. Renal protein handling in normal, hypertensive and diabetic man. Contributions to Nephrology 24: 139–152, 1981
Parving H-H, Jensen HA, Mogensen CE, Evrin P-E. Increased urinary albumin excretion rate in benign essential hypertension. Lancet 1: 1190–1192, 1974
Pedersen EB, Mogensen CE. Effects of antihypertensive treatment on urinary albumin excretion, glomerular filtration rate, and renal plasma flow in patients with essential hypertension. Scandinavian Journal of Clinical and Laboratory Investigation 36: 231–237, 1976
Samuelsson O. Hypertension in middle-aged men. Management, morbidity and prognostic factors during long-term hypertensive care. Acta Medica Scandinavica (Suppl.) 702: 1–79, 1985
Samuelsson O, Wilhelmsen L, Elmfeldt D, Pennert K, Wedel H, et al. Predictors of cardiovascular morbidity in treated hypertension results from the primary preventive trial in Göteborg, Sweden. Journal of Hypertension 3: 167–176, 1985
Sokolow M, Perloff D. The prognosis of essential hypertension treated conservatively. Circulation 23: 697–713, 1961
Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. III. Influence of age, diastolic pressure, and prior cardiovascular disease; further analysis of side effects. Circulation 45: 991–1004, 1972
Wolff FW, Lindeman RD. Effects of treatment on hypertension. Results of a controlled study. Journal of Chronic Disease 19: 227–240, 1966
Wollam GL, Gifford Jr RW. The kidney as a target organ in hypertension. Geriatrics 31: 71–79, 1976
Wihelmsen L, Tibblin G, Werkö L. A Primary Preventive Study of Gothenburg, Sweden. Preventive Medicine 1: 153–160, 1972
Yamada T, Ishihara M, Ichikawa K, Hiramatsu K. Proteinuria and renal function during antihypertensive treatment for essential hypertension. Journal of the American Geriatrics Society 28: 114–117, 1980
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Samuelsson, O. Proteinuria as a Prognostic Factor during Long Term Hypertensive Care. Drugs 35 (Suppl 5), 48–54 (1988). https://doi.org/10.2165/00003495-198800355-00008
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-198800355-00008