Clinical Implications of the Change in Glomerular Filtration Rate with Adrenergic Blockers in Patients with Morning Hypertension: The Japan Morning Surge-1 Study

Seiichi Shibasaki,Kazuomi Kario,Yoshio Matsui,Kazuyuki Shimada,Kazuo Eguchi

doi:10.1155/2013/413469

Seiichi Shibasaki, Kazuomi Kario + Show 3 more

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https://doi.org/10.1155/2013/413469

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Abstract

Background. The aim of this study was to clarify the relationship between the change in estimated glomerular filtration rate (eGFR) and urinary albumin by antihypertensive treatment. Methods. We randomized 611 treated patients with morning hypertension into either an added treatment group, for whom doxazosin was added to the current medication, or a control group, who continued their current medications. We compared the change in eGFR and urinary albumin creatinine ratio (UACR) between the groups. Results. The extent of the reduction in eGFR was significantly greater in the added treatment group than in the control group (−3.83 versus −1.08 mL/min/1.73 m2, P = 0.001). In multivariable analyses, the change in eGFR was positively associated with the change in UACR in the added treatment group (β = 0.20, P = 0.001), but not in the control group (β = −0.002, P = 0.97). When the changes in eGFR were divided by each CKD stage, eGFR was significantly more decreased in stage 1 than in the other stages in the added treatment group (P < 0.001), but no differences were seen in the control group (P = 0.44). Conclusion. The reduction of eGFR could be seen only in the early stage of CKD, and this treatment appeared to have no negative effect on renal function.

Highlights

Kidney disease is increasing rapidly along with the increasing prevalence of hypertension and the aging of many societies worldwide [1]
This study is a subanalysis of the Japan Morning Surge1 (JMS-1) Study, which was conducted from August 2003 to August 2005 by 20 doctors at 16 institutions (7 primary practices, 8 hospital-based outpatient clinics, and 1 specialized university hospital) in Japan
EGFR was significantly reduced in the added treatment group compared with the control group, and the change in estimated glomerular filtration rate (eGFR) was significantly and independently associated with the use of doxazosin and the change in morning systolic blood pressure (SBP), respectively. These results indicate that the reduction of eGFR was attributable to the blood pressure (BP) reduction and doxazosin per se

Summary

Introduction

Kidney disease is increasing rapidly along with the increasing prevalence of hypertension and the aging of many societies worldwide [1]. Antihypertensive treatment which suppresses sympathetic nerve hyperactivity might be pathophysiologically effective for preserving renal function in patients with morning hypertension, as was proven in the case of renal sympathetic nerve ablation [18]. The aim of this study was to clarify the relationship between the change in estimated glomerular filtration rate (eGFR) and urinary albumin by antihypertensive treatment. The extent of the reduction in eGFR was significantly greater in the added treatment group than in the control group (−3.83 versus −1.08 mL/min/1.73 m2, P = 0.001). When the changes in eGFR were divided by each CKD stage, eGFR was significantly more decreased in stage 1 than in the other stages in the added treatment group (P < 0.001), but no differences were seen in the control group (P = 0.44). The reduction of eGFR could be seen only in the early stage of CKD, and this treatment appeared to have no negative effect on renal function

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