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Albuminuria and Mortality in Hypertension
- Kristian Wachtell, MD, PhD;
- Michael Hecht Olsen, MD, PhD; and
- Hans Ibsen, MD
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IN RESPONSE:
When hazard ratios are adjusted for risk factors as in Tables 1 and 2 in our paper, blood pressure does not enter the Cox proportional hazards model. In our study sample, the relative impact of blood pressure on the relation between albuminuria and cardiovascular outcome was minor compared with the other risk factors that were included in the model. One reason may be that the LIFE study recruited patients with a relatively narrow blood pressure range (that is, systolic blood pressure between 160 and 200 mm Hg or diastolic blood pressure between 95 and 115 mm Hg) and that the blood pressure range was truncated at each end of the blood pressure spectrum. Because of this, blood pressure's relative impact on the relation between albuminuria and cardiovascular outcome may tend to be underestimated (1). However, although blood pressure itself was not included in the model, we entered the Framingham risk score (2) (which includes blood pressure) when estimating the increased cardiovascular morbidity and mortality per 10-fold increase in UACR. We therefore took any difference in blood pressure and other cardiovascular risk factors between levels of albuminuria into account.
Our paper estimated the extent to which baseline UACR predicts cardiovascular outcome in hypertensive patients. Drs. Coca and Buller are further interested in the very important issue of whether a reduction in UACR after 1 year of antihypertensive treatment is related to a reduction in cardiovascular morbidity and mortality. This issue was beyond the scope of our paper. However, we are currently analyzing how much change in albuminuria from baseline to 1 year of treatment affects cardiovascular morbidity and mortality, as well as the relation between cardiovascular outcome and change in albuminuria from baseline to any time point over the duration of the study. These analyses will be extensively reported in subsequent papers addressing cardiovascular outcome as well as the treatment effect of losartan compared with atenolol. However, preliminary analyses of cardiovascular outcomes (3) and treatment effects (4) in the LIFE study were reported at the June 2003 meeting of the European Society of Hypertension.
Kristian Wachtell, MD, PhD
Michael Hecht Olsen, MD, PhD
Hans Ibsen, MD
Copenhagen, Denmark
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
