Risk stratification by 24-hour ambulatory blood pressure and estimated glomerular filtration rate in 5322 subjects from 11 populations.

نویسندگان

  • José Boggia
  • Lutgarde Thijs
  • Yan Li
  • Tine W Hansen
  • Masahiro Kikuya
  • Kristina Björklund-Bodegård
  • Takayoshi Ohkubo
  • Jørgen Jeppesen
  • Christian Torp-Pedersen
  • Eamon Dolan
  • Tatiana Kuznetsova
  • Katarzyna Stolarz-Skrzypek
  • Valérie Tikhonoff
  • Sofia Malyutina
  • Edoardo Casiglia
  • Yuri Nikitin
  • Lars Lind
  • Emma Schwedt
  • Edgardo Sandoya
  • Kalina Kawecka-Jaszcz
  • Jan Filipovsky
  • Yutaka Imai
  • Jiguang Wang
  • Hans Ibsen
  • Eoin O'Brien
  • Jan A Staessen
چکیده

No previous study addressed whether in the general population estimated glomerular filtration rate (eGFR [Chronic Kidney Disease Epidemiology Collaboration formula]) adds to the prediction of cardiovascular outcome over and beyond ambulatory blood pressure. We recorded health outcomes in 5322 subjects (median age, 51.8 years; 43.1% women) randomly recruited from 11 populations, who had baseline measurements of 24-hour ambulatory blood pressure (ABP(24)) and eGFR. We computed hazard ratios using multivariable-adjusted Cox regression. Median follow-up was 9.3 years. In fully adjusted models, which included both ABP(24) and eGFR, ABP(24) predicted (P≤0.008) both total (513 deaths) and cardiovascular (206) mortality; eGFR only predicted cardiovascular mortality (P=0.012). Furthermore, ABP(24) predicted (P≤0.0056) fatal combined with nonfatal events as a result of all cardiovascular causes (555 events), cardiac disease (335 events), or stroke (218 events), whereas eGFR only predicted the composite cardiovascular end point and stroke (P≤0.035). The interaction terms between ABP(24) and eGFR were all nonsignificant (P≥0.082). For cardiovascular mortality, the composite cardiovascular end point, and stroke, ABP(24) added 0.35%, 1.17%, and 1.00% to the risk already explained by cohort, sex, age, body mass index, smoking and drinking, previous cardiovascular disease, diabetes mellitus, and antihypertensive drug treatment. Adding eGFR explained an additional 0.13%, 0.09%, and 0.14%, respectively. Sensitivity analyses stratified for ethnicity, sex, and the presence of hypertension or chronic kidney disease (eGFR <60 mL/min per 1.73 m(2)) were confirmatory. In conclusion, in the general population, eGFR predicts fewer end points than ABP(24). Relative to ABP(24), eGFR is as an additive, not a multiplicative, risk factor and refines risk stratification 2- to 14-fold less.

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عنوان ژورنال:
  • Hypertension

دوره 61 1  شماره 

صفحات  -

تاریخ انتشار 2013