TY - JOUR
AU - Davis, Barry
AB - Objective:a) To determine the prevalence of decreased glomerular filtration rate (GFR) and chronic kidney disease (CKD) at baseline in ALLHAT participants b) describe the association between GFR at baseline and history of cardiovascular disease (CVD) and c) describe the association between GFR and left ventricular hypertrophy (LVH) on ECG.Methods:The Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) is a practice based, randomized, multicenter clinical trial of antihypertensive pharmacologic treatment with 42419 participants aged 55 or older with one additional risk factor for CVD. Since there was limited general acceptance of equations to estimate GFR when the study was designed, a serum creatinine >2 mg/dl by history was used as the criterion to exclude patients with advanced renal dysfunction. Baseline serum creatinine was measured in a central lab with calibration allowing for application of the simplified MDRD equation to estimate GFR. Decreased GFR and CKD were defined according to the NKF-K/DOQI CKD clinical practice guidelines (unpublished draft). The Minnesota code was used to define LVH on the baseline ECG. History of CVD was as reported by the physician at the clinical center.Results:After adjustment for age, race, gender, body mass index, baseline blood pressure, LDL, HDL, triglycerides, diabetes and smoking by multiple logistic regression, lower estimated GFR was independently associated with a 6% higher history of cardiovascular disease (OR 0.94 per 10 ml/min/1.73 m2 p<0.0001), and a 10% higher prevalence of ECG-LVH (OR 0.90 per 10 ml/min/1.73 m2, p<0.0001).Conclusions:1) The prevalence of decreased GFR (61-90 ml/min/1.73 mm2) and CKD with moderate decreased GFR (31-60 ml/min/1.73 mm2) is very high in hypertensive patients older than 55 years with one or more risk factors for CVD.2) Patients with CKD with moderate or severe decreased GFR are more likely to have a history of CVD, ischemic ST-T wave changes, and LVH on ECG.3) Estimated GFR is independently associated with a history of CVD and the presence of ECG-LVH. (See Table)CKD with Severe ↓ GFR (≤29) (n = 227) 0.6%CKD with Moderate ↓ GFR (30–59) (n = 6932) 17.3%Mild ↓ GFR (60–89) (n = 22,809) 56.8%Normal or ↑ GFR (≥90) (n = 10,171) 25.3%Age (yrs mean ± SD)*70.6 (9.0)70.6 (7.8)67.2 (7.5)63.1 (6.5)Gender (% women)*62.6%52.3%44.6%46.0%History of old or age indeterminate MI or stroke (n, %)*61 (26.9%)1996 (28.8%)5318 (23.3%)1952 (19.2%)History of CABG/coronary angioplasty/other revascularization procedure (n, %)*32 (14.1%)1197 (17.3%)3078 (13.5%)940 (9.2%)Major ST depression or T wave inversion on baseline ECG by Minnesota code (n, %)*75 (33.0%)1705 (24.6%)4277 (18.8%)1626 (16.0%)LVH on baseline ECG (n, %)*25 (11.0%)415 (6.0%)952 (4.2%)393 (3.9%)*p<0.05
TI - P-400: Baseline characteristics of ALLHAT participants with impaired renal function: association with coexistent cardiovascular disease
JF - American Journal of Hypertension
DO - 10.1016/S0895-7061(02)02751-6
DA - 2002-04-01
UR - https://www.deepdyve.com/lp/oxford-university-press/p-400-baseline-characteristics-of-allhat-participants-with-impaired-0LyajyjyXm
SP - 175A
EP - 175A
VL - 15
IS - S3
DP - DeepDyve
ER -