3A.05: HYPERTENSION AND RISK OF EVENTS ASSOCIATED TO REDUCED EGFR. THE ESCARVAL-RISK STUDY. (June 2015) - Tellez-Plaza, M.
Abstract : Objective: The objective of the present study was to evaluate the potential impact of hypertension in the increased CVD risk associated with CKD in a population with at least one main CV risk factor (CVRF), hypertension, dyslipidemia or diabetes. Figure. No caption available. Design and method: 54, 620 men and women aged 30 years or older with at least one of main CVRF (hypertension, diabetes mellitus and/or dyslipidemia), who attended for routine health maintenance have been selected. Patients with a history of a previous CVD event were excluded. At the time of inclusion information about CVRF and their active treatments as well as smoking habit and biochemistry lab values were collected from the EHR. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI. Participants were followed-up for the first episode of hospitalization for myocardial infarction or stroke and all cause of death were collected. Interaction terms for dichotomous eGFR (>=60, <60 ml/min/1.73 m2) with the corresponding indicator variables for subgroups defined by sex, hypertension, diabetes, dyslipidemia, and obesity in separate models were calculated using the Wald test. Results: 54, 620 patients were included. Hypertension was present in 76%, dislipidemia 86%, diabetes in 35.5% and obesity in 41, 8%. A total of 7884 (14.4%) patients had eGFR below 60 ml/min/1.73 m2 and among them 1807 (3.3%) 45 ml/min/1.73 m2 or lower. During a time follow-up of 3.2 years, patients years exposure, 960 death were recorded. A significant increment in the risk for total mortality was observed in subjects with eGFR 45 ml/min/1.73 m2 or below adjusted for multiple potential confounders (HR 1.83, 1.28–2.62; CI 95th). In normotensive subjects the risk did not increase below 60 ml/min/1.73 m2 in contrast with the increment in hypertensives. (Figure 1 on the previous page). Conclusions: eGFR is a prevalent condition in patients with the main CV risk factors. eGFR below <45 ml/min/1.73 m2 increases mortality risk. Hypertension by itself had an important role in the risk of mortality in patients with low eGFR on top of other CV risk factors.