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Diuretic-based treatment and cardiovascular events in patients with mild renal dysfunction enrolled in the systolic
M Pahor1, R I Shorr, G W Somes
1Department of Preventive Medicine, University of Tennessee, College of Medicine, Memphis 38105, USA. mpahor@utmem1.utmem.edu
Insights
Diuretic-based treatment effectively reduced cardiovascular events in older adults with isolated systolic hypertension and mild kidney dysfunction. This hypertension management strategy is crucial for preventing adverse cardiovascular outcomes in this population.
Area of Science:
- Cardiology
- Nephrology
- Geriatrics
Background:
- Evidence for hypertension treatment benefits in patients with renal disease is limited.
- Isolated systolic hypertension is common in older adults, often coexisting with renal dysfunction.
Purpose of the Study:
- To evaluate the impact of diuretic-based treatment on cardiovascular events in elderly patients with isolated systolic hypertension and renal dysfunction.
Main Methods:
- A randomized trial involving 4336 participants aged 60+ with systolic blood pressure ≥160 mmHg.
- Participants received either placebo or chlorthalidone, with optional atenolol or reserpine, and were followed for 5 years.
- Cardiovascular event risk was analyzed based on baseline serum creatinine levels.
Main Results:
- Active treatment significantly reduced the risk of cardiovascular events across all baseline serum creatinine groups.
- The risk reduction for cardiovascular events ranged from 27% to 41% depending on the severity of renal dysfunction.
- Hypokalemia risk decreased with higher baseline serum creatinine levels; treatment did not elevate serum creatinine.
Conclusions:
- Diuretic-based antihypertensive therapy is effective in preventing cardiovascular events in older individuals with isolated systolic hypertension and mild renal dysfunction.
- This treatment approach offers significant cardiovascular protection for this vulnerable patient group.
Background:
It is expected that the treatment of hypertension in patients with renal disease decreases the risk of cardiovascular events, but the evidence in these patients is lacking.
Objective:
To assess the effect of diuretic-based treatment on cardiovascular events in patients with isolated systolic hypertension and renal dysfunction.
Methods:
A total of 4336 persons aged 60 years and older with systolic blood pressures of 160 mm Hg and higher and diastolic blood pressures of less than 90 mm Hg were randomly assigned to receive either placebo or chlorthalidone (12.5-25.0 mg/d), with the addition of atenolol (25-50 mg/d) or reserpine (0.05-0.10 mg/d) if needed, and observed for 5 years. The risk of first-occurring cardiovascular events, including stroke, transient ischemic attack, myocardial infarction, heart failure, coronary artery bypass surgery, angioplasty, aneurysm, endarterectomy, sudden death, or rapid death, was stratified according to baseline serum creatinine levels (35.4-84.0, 84.1-101.6, 101.7-119.3, and 119.4-212.2 micromol/L [0.4-0.9, 1.0-1.1, 1.2-1.3, and 1.4-2.4 mg/dL]).
Results:
Systolic blood pressure reduction was not affected by baseline serum creatinine levels. Active treatment did not affect the risk of serum creatinine levels becoming elevated during follow-up. The risk of hypokalemia with active treatment decreased significantly with increasing baseline serum creatinine levels. In the 4 baseline serum creatinine groups, the relative risk (95% confidence interval) of cardiovascular events developing with active treatment was 0.73 (0.54-0.97), 0.63 (0.49-0.82), 0.62 (0.44-0.87), and 0.59 (0.38-0.91). The results were similar for the outcomes of stroke or coronary artery events and in analyses stratified by sex or age.
Conclusion:
Diuretic-based treatment of patients with isolated systolic hypertension prevents the development of cardiovascular events in older persons with mild renal dysfunction.