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Interaction between renal function and microalbuminuria for cardiovascular risk in hypertension: the nordic diltiazem
Patrik Färbom1, Björn Wahlstrand, Peter Almgren
1Department of Clinical Sciences, Clinical Research Center, Entrance 72, Bldg 91, Fl 12, Malmö University Hospital, SE-205 02 Malmö, Sweden.
Insights
Renal function and microalbuminuria independently predict cardiovascular disease in hypertensive patients. Their combined assessment, including estimated glomerular filtration rate (eGFR), is crucial for accurate cardiovascular risk evaluation.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Hypertension is a major risk factor for cardiovascular disease (CVD).
- Renal dysfunction and microalbuminuria are known CVD risk factors in hypertensive individuals.
- The independent and interactive roles of renal function and microalbuminuria in CVD prediction require further clarification.
Purpose of the Study:
- To investigate renal function and microalbuminuria as independent predictors of future cardiovascular disease in hypertensive patients.
- To examine potential interactions between renal function and microalbuminuria in predicting cardiovascular events.
- To assess the combined prognostic value of renal function and microalbuminuria for cardiovascular risk stratification.
Main Methods:
- A cohort study involving 10,881 hypertensive patients followed for 4.5 years.
- Primary endpoints included fatal/nonfatal myocardial infarction, stroke, and cardiovascular deaths.
- Renal function assessed via creatinine and estimated glomerular filtration rate (eGFR) using MDRD and Cockcroft-Gault formulas; microalbuminuria measured.
- Cox proportional hazards models used to analyze risk, adjusting for covariates, and exploring interaction terms.
Main Results:
- Increased creatinine and decreased eGFR (both MDRD and Cockcroft-Gault) were independent predictors of cardiovascular events (P<0.001).
- Microalbuminuria also independently predicted cardiovascular events.
- A significant interaction was found between microalbuminuria and eGFR (Cockcroft-Gault) in predicting cardiovascular events (P=0.040).
- The cardiovascular risk associated with microalbuminuria increased as eGFR declined.
Conclusions:
- Both renal function and microalbuminuria provide independent prognostic information for cardiovascular risk in hypertensive patients.
- The interaction between microalbuminuria and eGFR highlights that the cardiovascular risk from microalbuminuria is amplified by declining kidney function.
- Simultaneous assessment of eGFR and microalbuminuria is essential for comprehensive cardiovascular risk evaluation and guiding intervention strategies.
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<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.
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