Follow-up of renal function in treated and untreated older patients with isolated systolic hypertension

Voyaki, Sofia M.; Staessen, Jan A.; Thijs, Lutgarde; Wang, Ji G.; Efstratopoulos, A.; Birkenhäger, W. H.; Leeuw, Peter W. de; Leonetti, Gastone; Nachev, C; Rodicio, José L.; Tuomilehto, Jaakko; Fagard, Robert

doi:10.1097/00004872-200103000-00020

Cited by 114 publications

(50 citation statements)

References 28 publications

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“…The discrepancy with the results from the SystChina trial, which also found a relationship between uric acid and complications, may be explained by the fact that other risk factors, such as elevated cholesterol, were less prominent in the Chinese patients (10). The reason that we found uric acid to be a less conspicuous indicator of cardiovascular risk could also be due to the limited increase in serum creatinine that we encountered in this study (25). Perhaps, a greater loss of renal function or a more pronounced fall in extracellular fluid volume (such as may occur during diuretic treatment) is necessary to unmask the role of uric acid as an independent marker of risk.…”

Section: Discussioncontrasting

confidence: 99%

Prognostic Significance of Renal Function in Elderly Patients with Isolated Systolic Hypertension

Leeuw¹,

Thijs

Birkenhäger

et al. 2002

Journal of the American Society of Nephrology

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176

116

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Abstract. Several reports suggest that markers of renal function such as serum creatinine, serum uric acid, and urinary excretion of protein may be related to cardiovascular complications and mortality. This study analyzed the data from the Syst-Eur trial, which was a randomized, placebo-controlled, double-blind intervention trial in elderly patients with isolated systolic hypertension. The purpose was to evaluate whether serum levels of creatinine and uric acid and urinary protein excretion at entry are related to subsequent morbidity and mortality. Incidence rates of total mortality, cardiovascular mortality, stroke (fatal as well as nonfatal), coronary events, and all cardiovascular endpoints were calculated for each quintile of serum creatinine or serum uric acid or for each category of protein excretion (none, trace, and overt). Crude and adjusted relative hazard rates were also determined for each 20 M increase in serum creatinine, each 50 M increase in serum uric acid, and for each protein excretion category. Even when adjusted for age, gender, and various other covariates, serum creatinine was significantly associated with a worse prognosis. There was an U-shaped relationship between serum uric acid and total mortality, but otherwise no obvious relationships were detected between serum uric acid levels and complications when appropriate adjustments were made for confounding variables. Proteinuria at entry was a significant predictor of total mortality and all cardiovascular endpoints. It is concluded that higher levels of serum creatinine and trace or overt proteinuria are associated with an increased number of cardiovascular events and with a higher mortality in patients with isolated systolic hypertension.Cardiovascular prognosis in patients with hypertension depends not only on the level of BP and associated risk factors but also on the presence of target organ damage. For instance, after left ventricular hypertrophy has developed as a result of long-standing hypertension, this complication becomes a risk factor in its own right and a predictor not only of further cardiac abnormalities (1) but also of other atherothrombotic events, such as ischemic stroke (2). Similarly, the presence of cerebrovascular abnormalities may raise cardiovascular risk over and above that conferred by hypertension itself. Although the brain and the heart are the prime targets of the hypertensive process, the kidney is also frequently affected. Evidence is accumulating that renal damage, once present, may also independently contribute to an increased cardiovascular risk (3). Many studies on this issue, however, were either retrospective or did not follow a rigid prospective protocol. Consequently, only limited information is available concerning the extent to which renal damage modifies the risk of future cardiovascular complications. This prompted us to address this question using the Syst-Eur database. The Syst-Eur trial was a large, prospective, double-blind, placebo-controlled trial that examined whether active antihypert...

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Section: Discussioncontrasting

confidence: 99%

Prognostic Significance of Renal Function in Elderly Patients with Isolated Systolic Hypertension

Leeuw¹,

Thijs

Birkenhäger

et al. 2002

Journal of the American Society of Nephrology

Self Cite

176

116

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“…erates renal progression in hypertensive subjects (21,22,(147)(148)(149)(150)(151)(152)(153)(154)(155). The usage of diuretics in the EWPHE (22,153), Syst-Eur (149), SHEP (150), INSIGHT (151), and ALLHAT (152) studies were all statistically associated with a greater decline in renal function compared with the other treatment groups.…”

Section: Specific Characteristics That Favor An Increased Risk For Rementioning

confidence: 99%

Essential Hypertension, Progressive Renal Disease, and Uric Acid

Johnson

Segal

Srinivas

et al. 2005

Journal of the American Society of Nephrology

263

171

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Hypertension and hypertension-associated ESRD are epidemic in society. The mechanisms responsible for renal progression in mild to moderate hypertension and those groups most at risk need to be identified. Historic, epidemiologic, clinical, and experimental studies on the pathogenesis of hypertension and hypertension-associated renal disease are reviewed and an overview/hypothesis for the mechanisms involved in renal progression is presented. There is increasing evidence that hypertension may exist in one of two forms/stages. The first stage, most commonly observed in early or borderline hypertension, is characterized by salt-resistance, normal or only slightly decreased GFR, relatively normal or mild renal arteriolosclerosis, and normal renal autoregulation. This group is at minimal risk for renal progression. The second stage, characterized by salt-sensitivity, renal arteriolar disease, and blunted renal autoregulation, defines a group at highest risk for the development of microalbuminuria, albuminuria, and progressive renal disease. This second stage is more likely to be observed in blacks, in subjects with gout or hyperuricemia, with low level lead intoxication, or with severe obesity/metabolic syndrome. The two major mechanistic pathways for causing impaired autoregulation at mild to moderate elevations in BP appear to be hyperuricemia and/or low nephron number. Understanding the pathogenetic pathways mediating renal progression in hypertensive subjects should help identify those subjects at highest risk and may provide insights into new therapeutic maneuvers to slow or prevent progression.

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“…In the patients assigned randomly to receive active treatment, the incidence of mild renal dysfunction decreased by 64%, and that of proteinuria by 33%. [86] 250…”

Section: Effects On the Progression Of Human Renal Diseasementioning

confidence: 99%

Calcium Antagonists and Renal Failure Progression

Robles

2008

Renal Failure

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Although tighter blood pressure control is considered the main mechanism for preventing the progression of chronic renal failure, angiotensin-converting enzyme inhibitors and angiotensin receptors blockers seem to have an additional organ protective role. The effects of calcium antagonists in renal disease are not so clearly defined. Calcium antagonists have pleiotropic effects that might contribute to protect the kidney, such as attenuating mesangial entrapment of macromolecules, countervailing the mitogenic effect of platelet-derived growth factors and platelet-activating factors, and suppressing mesangial cell proliferation. They could also act as free radical scavengers and inhibit the renal effects of endothelin. Some evidence has been accumulated demonstrating that certain new dihydropyridinic calcium antagonists may affect postglomerular as well as preglomerular vessels, resulting in decreased filtration fraction and nephroprotective effect as renin-angiotensin axis-blocking drugs. Though there are few reports on the clinical renal effects of new calcium antagonists, they have rendered promising results. Manidipine does not increase proteinuria as do some classic calcium antagonists, and lercanidipine combined with renin-angiotesin axisblocking drugs reduce proteinuria. Both drugs have been shown to decrease microalbuminuria when administered alone.

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Follow-up of renal function in treated and untreated older patients with isolated systolic hypertension

Cited by 114 publications

References 28 publications

Prognostic Significance of Renal Function in Elderly Patients with Isolated Systolic Hypertension

Prognostic Significance of Renal Function in Elderly Patients with Isolated Systolic Hypertension

Essential Hypertension, Progressive Renal Disease, and Uric Acid

Calcium Antagonists and Renal Failure Progression

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