Impact of hypertension on outcomes in patients with membranous nephropathy

Objective: Hypertension often accompanies glomerular diseases. There is existing data regarding the relationship between hypertension and worse outcomes in primary membranous nephropathy (MN). We aimed to evaluate the impact of hypertension on both renal and cardiovascular outcomes in cases with primary MN. Design and method: All patients diagnosed with MN between 2001 and 2022 were screened and cases with accessible data were enrolled. Coronary revascularization, occurence of atrial fibrillation, stroke, venous thromboembolic events and all-cause mortality were determined as cardiovascular outcomes. Progression to end-stage renal disease was described as the renal outcome. Results: A total of 172 patients were included. Mean age of the study population was 47.6±14.2 years and 57.6% of them were male. Hypertension was present in 74 (43%) patients. Patients with hypertension were older (54.8±12.1 vs. 41.5±13.2; p<0.001) and baseline glomerular filtration rate (85 vs. 110; p<0.001) was lower in cases with hypertension. Median follow-up was 109.4 (4.8-265.6) months. Baseline characteristics and outcomes are presented in Table 1. Coronary revascularization (16.2% vs. 3.1%; p=0.005) and all-cause mortality rates (24.3% vs. 8.2%; p=0.007) were significantly higher in patients with hypertension. There were no differences in the rates of stroke, atrial fibrillation, progression to end-stage renal disease and venous thromboembolic events between the two groups (Table 1). The predictors of all-cause mortality were coronary artery disease (HR:3.8, 95% CI=1.1-12.6; p=0.027) and albumin level (HR:0.4, 95% CI=0.18-0.86-12.6; p=0.019). Conclusions: Coronary revascularization and all-cause mortality rates are higher in primary MN cases with hypertension. Hypertension is not an independent predictor of all-cause mortality however increased comorbidity burden, accompanied coronary artery disease and low serum albumin levels indicating higher amounts of albuminuria seems to be the underlying causes of increased mortality.