Mortality and morbidity in relation to changes in @entity633 , XXXX status and systolic blood pressure: an analysis of the ONTARGET and TRANSCEND studies.

@entity1 @entity413 @entity65 @entity633
AIMS/HYPOTHESIS: Urinary albumin excretion is a strong predictor of @entity65 . It is uncertain whether improvement from microalbuminuria or deterioration from normoalbuminuria over time in @entity1 with differing changes in @entity413 and BP change their cardiovascular risk. METHODS: Data on mortality, cardiovascular and renal outcomes were analysed in 22,984 @entity1 from two large parallel randomised clinical trials followed for 56 months. A central laboratory analysed first morning spot urine samples at baseline and after 24 months, and events were recorded over the subsequent 32 months. @entity1 were stratified by changes in @entity633 , @entity413 status and mean systolic BP over 2 years. RESULTS: There was a strong association between @entity633 status and all-cause and cardiovascular mortality and combined cardiovascular and renal endpoints (all p < 0.0001). Changes in systolic BP control had no effect on mortality, whereas @entity413 status was significantly associated with all outcomes. Irrespective of BP control or @entity413 status, @entity1 showing an improvement from microalbuminuria to normoalbuminuria after 2 years were at a lower risk of all outcome measures than @entity1 showing deterioration from normoalbuminuria to microalbuminuria (HR for all-cause mortality 0.65 [0.52-0.83], p = 0.0004). CONCLUSIONS/INTERPRETATION: @entity1 who showed improvement to normoalbuminuria over 2 years were at lower risk of all-cause and cardiovascular mortality and of cardiovascular and renal events than those who deteriorated to microalbuminuria over time. @entity633 over time was significantly better than @entity413 status and BP control in predicting mortality and both cardiovascular and renal outcomes in @entity1 at a high cardiovascular risk.
