Urinary Albumin Evolution in Saudi Hypertensive Patients with the Current Treatment Local Algorithm an Observational Study

Abstract

An observational study design was chosen to reflect real-life conditions and draw on the efficacy of pharmacological management of hypertension in control- ling albuminuria. Microalbuminuria is brought on by hypertension, and if it is not controlled, it can lead to kidney damage. Although the primary goal of antihypertensive therapy is to lower blood pressure (BP), it has also been demonstrated to reduce urine albumin excretion. Antihypertensive drugs' renoprotective effects include slowing or stopping the progression of albuminuria. A national, multicenter, observational, longitudinal study (RATIONAL) evaluated the correlation between antihy- pertensive treatment effect and microalbuminuria evolu- tion over 12 months, between May-2016 and July-2018.

Of 409 patients, 60% had uncontrolled BP at baseline, down to 34% at 12 months. Over 80% of patients were on mono or double antihypertensive therapy, and angiotensin- receptor blockers (ARB) topped the list of medication classes. Albumin–creatinine ratio (ACR) significantly decreased throughout the study, indicating that BP control is paramount to prevent target organ damage. BP change most strongly correlated with ACR change upon triple therapy (ARB + calcium channel blocker + \(\beta\)-blocker). Importantly, 25% (at 6 months) and 38% (at 12 months) of patients reverted back to normoalbuminuria, mostly upon renin-angiotensin system blockers. Around 80% of study patients had also diabetes, a common condition in KSA, which significantly hindered achievement of normoalbuminuria at 12 months. This study gave an overview of pharmacological man- agement of hypertension in kidney damage patients, and shed light on high diabetes prevalence in this patient population.