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Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate.

Abstract

BACKGROUND

Chronic kidney disease is common in older patients with hypertension.

OBJECTIVE

To compare rates of coronary heart disease (CHD) and end-stage renal disease (ESRD) events; to determine whether glomerular filtration rate (GFR) independently predicts risk for CHD; and to report the efficacy of first-step treatment with a calcium-channel blocker (amlodipine) or an angiotensin-converting enzyme inhibitor (lisinopril), each compared with a diuretic (chlorthalidone), in modifying cardiovascular disease (CVD) outcomes in high-risk patients with hypertension stratified by GFR.

DESIGN

Post hoc subgroup analysis.

SETTING

Multicenter randomized, double-blind, controlled trial.

PARTICIPANTS

Persons with hypertension who were 55 years of age or older with 1 or more risk factors for CHD and who were stratified into 3 baseline GFR groups: normal or increased (> or = 90 mL/min per 1.73 m2; n = 8126 patients), mild reduction (60 to 89 mL/min per 1.73 m2; n = 18,109 patients), and moderate or severe reduction (< 60 mL/min per 1.73 m2; n = 5662 patients).

INTERVENTIONS

Random assignment to chlorthalidone, amlodipine, or lisinopril.

MEASUREMENTS

Rates of ESRD, CHD, stroke, and combined CVD (CHD, coronary revascularization, angina, stroke, heart failure, and peripheral arterial disease).

RESULTS

In participants with a moderate to severe reduction in GFR, 6-year rates were higher for CHD than for ESRD (15.4% vs. 6.0%, respectively). A baseline GFR of less than 53 mL/min per 1.73 m2 (compared with >104 mL/min per 1.73 m2) was independently associated with a 32% higher risk for CHD. Amlodipine was similar to chlorthalidone in reducing CHD (16.0% vs. 15.2%, respectively; hazard ratio, 1.06 [95% CI, 0.89 to 1.27]), stroke, and combined CVD (CHD, coronary revascularization, angina, stroke, heart failure, and peripheral arterial disease), but less effective in preventing heart failure. Lisinopril was similar to chlorthalidone in preventing CHD (15.1% vs. 15.2%, respectively; hazard ratio, 1.00 [CI, 0.84 to 1.20]), but was less effective in reducing stroke, combined CVD events, and heart failure.

LIMITATIONS

Proteinuria data were not available, and combination therapies were not tested.

CONCLUSIONS

Older high-risk patients with hypertension and reduced GFR are more likely to develop CHD than to develop ESRD. A low GFR independently predicts increased risk for CHD. Neither amlodipine nor lisinopril is superior to chlorthalidone in preventing CHD, stroke, or combined CVD, and chlorthalidone is superior to both for preventing heart failure, independent of level of renal function.

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  • Authors+Show Affiliations

    ,

    Case Western Reserve University, Cleveland, Ohio, USA.

    , , , , , , , , , , , , , , , , , ,

    Source

    Annals of internal medicine 144:3 2006 Feb 07 pg 172-80

    MeSH

    Aged
    Amlodipine
    Antihypertensive Agents
    Cardiovascular Diseases
    Chlorthalidone
    Chronic Disease
    Double-Blind Method
    Female
    Glomerular Filtration Rate
    Humans
    Hypertension
    Kidney Diseases
    Kidney Failure, Chronic
    Lisinopril
    Male
    Middle Aged
    Risk Factors

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    16461961

    Citation

    Rahman, Mahboob, et al. "Cardiovascular Outcomes in High-risk Hypertensive Patients Stratified By Baseline Glomerular Filtration Rate." Annals of Internal Medicine, vol. 144, no. 3, 2006, pp. 172-80.
    Rahman M, Pressel S, Davis BR, et al. Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med. 2006;144(3):172-80.
    Rahman, M., Pressel, S., Davis, B. R., Nwachuku, C., Wright, J. T., Whelton, P. K., ... Wiegmann, T. (2006). Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Annals of Internal Medicine, 144(3), pp. 172-80.
    Rahman M, et al. Cardiovascular Outcomes in High-risk Hypertensive Patients Stratified By Baseline Glomerular Filtration Rate. Ann Intern Med. 2006 Feb 7;144(3):172-80. PubMed PMID: 16461961.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. AU - Rahman,Mahboob, AU - Pressel,Sara, AU - Davis,Barry R, AU - Nwachuku,Chuke, AU - Wright,Jackson T,Jr AU - Whelton,Paul K, AU - Barzilay,Joshua, AU - Batuman,Vecihi, AU - Eckfeldt,John H, AU - Farber,Michael A, AU - Franklin,Stanley, AU - Henriquez,Mario, AU - Kopyt,Nelson, AU - Louis,Gail T, AU - Saklayen,Mohammad, AU - Stanford,Carole, AU - Walworth,Candace, AU - Ward,Harry, AU - Wiegmann,Thomas, AU - ,, PY - 2006/2/8/pubmed PY - 2006/3/8/medline PY - 2006/2/8/entrez SP - 172 EP - 80 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 144 IS - 3 N2 - BACKGROUND: Chronic kidney disease is common in older patients with hypertension. OBJECTIVE: To compare rates of coronary heart disease (CHD) and end-stage renal disease (ESRD) events; to determine whether glomerular filtration rate (GFR) independently predicts risk for CHD; and to report the efficacy of first-step treatment with a calcium-channel blocker (amlodipine) or an angiotensin-converting enzyme inhibitor (lisinopril), each compared with a diuretic (chlorthalidone), in modifying cardiovascular disease (CVD) outcomes in high-risk patients with hypertension stratified by GFR. DESIGN: Post hoc subgroup analysis. SETTING: Multicenter randomized, double-blind, controlled trial. PARTICIPANTS: Persons with hypertension who were 55 years of age or older with 1 or more risk factors for CHD and who were stratified into 3 baseline GFR groups: normal or increased (> or = 90 mL/min per 1.73 m2; n = 8126 patients), mild reduction (60 to 89 mL/min per 1.73 m2; n = 18,109 patients), and moderate or severe reduction (< 60 mL/min per 1.73 m2; n = 5662 patients). INTERVENTIONS: Random assignment to chlorthalidone, amlodipine, or lisinopril. MEASUREMENTS: Rates of ESRD, CHD, stroke, and combined CVD (CHD, coronary revascularization, angina, stroke, heart failure, and peripheral arterial disease). RESULTS: In participants with a moderate to severe reduction in GFR, 6-year rates were higher for CHD than for ESRD (15.4% vs. 6.0%, respectively). A baseline GFR of less than 53 mL/min per 1.73 m2 (compared with >104 mL/min per 1.73 m2) was independently associated with a 32% higher risk for CHD. Amlodipine was similar to chlorthalidone in reducing CHD (16.0% vs. 15.2%, respectively; hazard ratio, 1.06 [95% CI, 0.89 to 1.27]), stroke, and combined CVD (CHD, coronary revascularization, angina, stroke, heart failure, and peripheral arterial disease), but less effective in preventing heart failure. Lisinopril was similar to chlorthalidone in preventing CHD (15.1% vs. 15.2%, respectively; hazard ratio, 1.00 [CI, 0.84 to 1.20]), but was less effective in reducing stroke, combined CVD events, and heart failure. LIMITATIONS: Proteinuria data were not available, and combination therapies were not tested. CONCLUSIONS: Older high-risk patients with hypertension and reduced GFR are more likely to develop CHD than to develop ESRD. A low GFR independently predicts increased risk for CHD. Neither amlodipine nor lisinopril is superior to chlorthalidone in preventing CHD, stroke, or combined CVD, and chlorthalidone is superior to both for preventing heart failure, independent of level of renal function. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/16461961/Cardiovascular_outcomes_in_high_risk_hypertensive_patients_stratified_by_baseline_glomerular_filtration_rate_ L2 - https://www.annals.org/article.aspx?volume=144&amp;issue=3&amp;page=172 DB - PRIME DP - Unbound Medicine ER -