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Interaction Between Renal Function and Microalbuminuria for Cardiovascular Risk in Hypertension The Nordic Diltiazem Study

Svensson, Patrik LU ; Wahlstrand, Bjorn; Almgren, Peter LU ; Skrtic, Stanko; Lanke, Jan LU ; Weiss, Lars; Kjeldsen, Sverre; Hedner, Thomas and Melander, Olle LU (2008) In Hypertension 52(1). p.115-122
Abstract
We investigated whether renal function and microalbuminuria are independent predictors and whether any interaction exists between them, regarding future cardiovascular disease in hypertensive patients (n=10 881) followed for 4.5 years. The primary end points (PEs) were fatal and nonfatal myocardial infarction and stroke and other cardiovascular deaths. Creatinine and glomerular filtration rate (GFR), estimated using the formulas of the Modification of Diet in Renal Disease study group and Cockroft and Gault and in a subsample (n=4929) of microalbuminuria and interaction terms of microalbuminuria and renal function, were related to the risk of the PE using Cox proportional hazards model after full adjustment. Increased creatinine (P <... (More)
We investigated whether renal function and microalbuminuria are independent predictors and whether any interaction exists between them, regarding future cardiovascular disease in hypertensive patients (n=10 881) followed for 4.5 years. The primary end points (PEs) were fatal and nonfatal myocardial infarction and stroke and other cardiovascular deaths. Creatinine and glomerular filtration rate (GFR), estimated using the formulas of the Modification of Diet in Renal Disease study group and Cockroft and Gault and in a subsample (n=4929) of microalbuminuria and interaction terms of microalbuminuria and renal function, were related to the risk of the PE using Cox proportional hazards model after full adjustment. Increased creatinine (P < 0.001), decreased GFR from Cockroft and Gault (P=0.001), and decreased GFR from the Modification of Diet in Renal Disease study group (P=0.001) were all independent risk factors for the PE. Stepwise exclusion of patients with the poorest renal function excluded the possibility that the relationship between decreasing renal function and the PE was driven only by patients with severely impaired renal function. Microalbuminuria and all 3 of the indices of renal function predicted the PE independent of each other. There was a significant interaction between microalbuminuria and GFR from Cockroft and Gault (P=0.040) in prediction of the PE. Both renal function and microalbuminuria add independent prognostic information regarding cardiovascular risk in hypertensive patients. The cardiovascular risk associated with microalbuminuria increases with a decline in GFR, as demonstrated by a significant interaction between microalbuminuria and GFR from Cockroft and Gault. Because estimation of the total cardiovascular risk is essential for the aggressiveness of risk factor interventions, simultaneous inclusion of GFR and microalbuminuria in global cardiovascular risk assessment is essential. (Hypertension. 2008;52:115-122.) (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hypertension, creatinine, glomerular filtration rate, cardiovascular risk, interaction, microalbuminuria
in
Hypertension
volume
52
issue
1
pages
115 - 122
publisher
Lippincott Williams & Wilkins
external identifiers
  • wos:000256880000018
  • scopus:46449117134
ISSN
1524-4563
DOI
10.1161/HYPERTENSIONAHA.107.109264
language
English
LU publication?
yes
id
dcbdafc8-4721-4b51-bb72-a9667b0a7a7a (old id 1375175)
date added to LUP
2009-05-08 14:57:13
date last changed
2017-01-01 04:53:57
@article{dcbdafc8-4721-4b51-bb72-a9667b0a7a7a,
  abstract     = {We investigated whether renal function and microalbuminuria are independent predictors and whether any interaction exists between them, regarding future cardiovascular disease in hypertensive patients (n=10 881) followed for 4.5 years. The primary end points (PEs) were fatal and nonfatal myocardial infarction and stroke and other cardiovascular deaths. Creatinine and glomerular filtration rate (GFR), estimated using the formulas of the Modification of Diet in Renal Disease study group and Cockroft and Gault and in a subsample (n=4929) of microalbuminuria and interaction terms of microalbuminuria and renal function, were related to the risk of the PE using Cox proportional hazards model after full adjustment. Increased creatinine (P &lt; 0.001), decreased GFR from Cockroft and Gault (P=0.001), and decreased GFR from the Modification of Diet in Renal Disease study group (P=0.001) were all independent risk factors for the PE. Stepwise exclusion of patients with the poorest renal function excluded the possibility that the relationship between decreasing renal function and the PE was driven only by patients with severely impaired renal function. Microalbuminuria and all 3 of the indices of renal function predicted the PE independent of each other. There was a significant interaction between microalbuminuria and GFR from Cockroft and Gault (P=0.040) in prediction of the PE. Both renal function and microalbuminuria add independent prognostic information regarding cardiovascular risk in hypertensive patients. The cardiovascular risk associated with microalbuminuria increases with a decline in GFR, as demonstrated by a significant interaction between microalbuminuria and GFR from Cockroft and Gault. Because estimation of the total cardiovascular risk is essential for the aggressiveness of risk factor interventions, simultaneous inclusion of GFR and microalbuminuria in global cardiovascular risk assessment is essential. (Hypertension. 2008;52:115-122.)},
  author       = {Svensson, Patrik and Wahlstrand, Bjorn and Almgren, Peter and Skrtic, Stanko and Lanke, Jan and Weiss, Lars and Kjeldsen, Sverre and Hedner, Thomas and Melander, Olle},
  issn         = {1524-4563},
  keyword      = {hypertension,creatinine,glomerular filtration rate,cardiovascular risk,interaction,microalbuminuria},
  language     = {eng},
  number       = {1},
  pages        = {115--122},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {Hypertension},
  title        = {Interaction Between Renal Function and Microalbuminuria for Cardiovascular Risk in Hypertension The Nordic Diltiazem Study},
  url          = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.107.109264},
  volume       = {52},
  year         = {2008},
}