[PP.07.17] GLYCATED HEMOGLOBIN A1C IS A STRONG DETERMINANT OF KIDNEY FUNCTION AND ALBUMIN EXCRETION IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME. (September 2017)

• Record Type: Journal Article
• Authors: Pietri, P.; Vlachopoulos, C.; Ioakeimidis, N.; Terentes-Printzios, D.; Stefanadis, C.
• Is Part Of: Journal of hypertension. Volume 35(2017)Supplement 2
• Publication Date: 2017-09
• Subjects: Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/01.hjh.0000523374.38411.97
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Objective: Kidney dysfunction, defined either as estimated glomerular filtration rate (eGFR) below 60 ml/min/1.73 m 2 or as the presence of microalbuminuria, is associated with adverse cardiovascular events in hypertensive patients. Metabolic syndrome (MS) is a cluster of cardiometabolic abnormalities and conveys a high cardiovascular risk. Insulin resistance constitutes the main underlying pathophysiological mechanism of MS. Whether it is insulin resistance or hyperglycemia per se that has the greater effect on kidney function in patients with MS, is not thoroughly investigated. Design and method: We studied 526 never treated hypertensive patients with MS, defined by ATP III criteria, free from overt cardiovascular disease. Kidney function was estimated in all patients by calculating eGFR using the MDRD formula. Urine albumin concentration was measured after 24 h urine collection and albumin-to-creatinine ratio (ACR) was calculated. Insulin resistance was assessed by applying the homeostasis model assessment (HOMA-IR). Glycated hemoglobin A1c (HbA1c) was measured in all participants. Results: Mean values of HbA1c and HOMA-IR were 5.9% and 3.4, respectively. In univariate analysis, eGFR was related to age, male gender, smoking, total cholesterol, hsCRP, fasting glucose, HbA1c (r = −0.23, p < 0.001) and HOMA-IR (r = −0.09, p = 0.04). Accordingly, ACR was related to age, smoking, BMI, waist-to-hip ratio, mean arterial pressure, hsCRP, fasting glucose, HbA1c (r = 0.37, p < 0.001) and HOMA-IR (r = 0.22, p < 0.001). In linear regression analysis, after adjustment for several confounders, an independent association was demonstrated between eGFR and HbA1c (b = −0.38, p = 0.04), whereas the association of eGFR with HOMA-IR became non significant (b = −0.02, p = NS). Similar pattern was also evident for ACR since a strong association with HbA1c (b = 0.58, p = 0.001) was established, whereas no relationship between ACR and HOMA-IR was observed (b = 0.06, p = NS). Conclusions: In hypertensive patients with MS, HbA1c is a strong determinant of kidney function independently of insulin resistance or other components of MS. It might be suggested that the impaired kidney function and microalbuminuria, associated with abnormal glucose regulation, may mediate part of the increased cardiovascular risk related to MS. Thus, measurement of HbA1c may add in risk stratification and may serve as a treatment target in hypertensive patients with MS.