Kidney Week

Abstract: SA-PO1001

Prevalence of Angiotensin II Type 1 Receptor Antibodies (AT1RAbs) in Persons with Hypertension and Relation to Blood Pressure and Kidney Outcomes

Session Information

• Hypertension and CVD: Mechanisms - II
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Hypertension and CVD

• 1403 Hypertension and CVD: Mechanisms

Authors

• Philogene, Mary Carmelle, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

Mary Carmelle Philogene,

• Han, Dingfen, Johns Hopkins School of Medicine, Baltimore, Maryland, United States

Dingfen Han,

• Zonderman, Alan B., Intramural Research Program, NIA, NIH, Baltimore, Maryland, United States

Alan B. Zonderman,

• Evans, Michele Kim, National Institutes of Health/National Institute on Aging, Baltimore, Maryland, United States

Michele Kim Evans,

• Crews, Deidra C., Johns Hopkins School of Medicine, Baltimore, Maryland, United States

Deidra C. Crews,

Background

AT1RAbs are associated with vascular hypertension and allograft dysfunction after kidney transplantation. We aimed to determine the prevalence of AT1RAb in a non-transplanted hypertensive population and the relationship to blood pressure (BP) control and kidney outcomes.

Methods

We used data on 1006 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study participants with hypertension, and treated with angiotensin receptor blockers (ARB), angiotensin converting enzyme inhibitors (ACEi) or other anti-hypertensive medications. AT1RAb detection was performed by ELISA (One Lambda) and levels ≥ 17 units/ml were considered positive. BP, uncontrolled BP (systolic BP ≥140 or diastolic ≥90 mmHg), albuminuria [urine albumin-to-creatinine ratio (ACR) ≥30mg/g] and rapid kidney function decline (loss of eGFR >3ml/min per 1.73m² per year over a median of 5 years) were compared for AT1RAb positive (+) versus negative (-) participants using descriptive statistics and multivariable regression models.

Results

Overall, 132 (13%) participants were AT1RAb+. Compared to AT1RAb-, AT1RAb+ persons were more likely to be Caucasian (47% versus 37%) and non-smokers (44% versus 30%). In models adjusting for age, sex and race, AT1RAb+ persons had 2.6 mmHg higher diastolic BP than AT1RAb- persons (p=0.01). The adjusted odds ratio (aOR) for uncontrolled BP was 1.33 (95% CI 0.9, 2.0) comparing AT1RAb+ to AT1RAb- persons. In adjusted models, AT1RAb+ persons treated with either ARB or ACEi had 12.3 mmHg higher systolic and 5.4 mmHg higher diastolic BP compared to AT1RAb+ persons using other BP medications (p=0.003 and 0.03); aOR for uncontrolled BP was 1.48 (95% CI 0.68-3.21). BP did not differ for AT1RAb- participants regardless of medication. The prevalence of albuminuria was similar between AT1RAb+ (19.1%) and AT1RAb- (19.5%) groups. Rapid kidney function decline occured in 18.1% of AT1RAb+ and 15.5% of AT1RAb- persons (p=0.5). There was no statistically significant association between AT1RAb status and rapid kidney function decline (aOR 1.23; 95% CI 0.74-2.05).

Conclusion

AT1RAbs were associated with higher diastolic BP in this hypertensive population, and use of ARB or ACEi was associated with higher BP among AT1RAb+ persons compared to use of other medications.

Funding

• Private Foundation Support