Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group.

Abstract

on behalf of the Hypertension Detection and Follow-up Program Cooperative GroupThe Hypertension Detection and Follow-up Program followed up 10,940 persons for 5 years in a community-based, randomized, controlled trial of treatment for hypertension. Participants were randomized to one of two treatment groups, stepped care and referred care. The primary end point of the study was all-cause mortality, with morbid events involving the heart, brain, and kidney as secondary end points. Loss of renal function, ascertained by a change in serum creatinine, was among these secondary events. Baseline serum creatinine concentration had a significant prognostic value for 8-year mortality. For persons with a serum creatinine concentration greater than or equal to 1.7 mg/dl, 8-year mortality was more than three times that of all other participants. The estimated 5-year incidence of substantial decline in renal function was 21.7/1,000 in the stepped-care group and 24.6/1,000 in the referred-care group. Among persons with a baseline serum creatinine level between 1.5 and 1.7 mg/dl, the 5-year incidence of decline was 113.3/1,000 (stepped care) and 226.6/1,000 (referred care) (p<0.01). The incidence of decline in renal function was greater in men, blacks, and older adults, as well as in those with higher entry diastolic blood pressure. Among persons with a baseline serum creatinine level greater than or equal to 1.7 mg/dl, serum creatinine concentration declined by 25% or more in 28.6% of stepped-care and 25.2% of referred-care participants. Although the incidence of clinically significant hypercreatininemia in a hypertensive population is low, an elevated serum creatinine concentration is a very potent independent risk factor for mortality. The slightly lower rate of development of hypercreatininemia and the higher rate of improvement in stepped-care compared with referred-care participants is consistent with the belief that aggressive treatment of hypertension may reduce renal damage and the associated increased risk of death. (Hypertension 1989;13(suppl I):I-80-1-93) H ypertension is one of the most common adult chronic diseases for which treatment is available. The disease affects all race, sex, and age groups but has a markedly higher prevalence among blacks 1 and a concomitantly higher mortality from its sequelae. 2 The risk associated with hypertension includes fatal and nonfatal outcomes

Effects of Early and Late Intervention with Epoetin α on Left Ventricular Mass among Patients with Chronic Kidney Disease (Stage 3 or 4)

“…At the commencement of the study, 21 of 74 patients in group A and 25 of 78 in group B demonstrated echocardiographic evidence of LVH. When patients were divided into groups with or without LVH at the commencement of the trial (irrespective of treatment group), those with preexisting LVH demonstrated a significant decrease in LVMi (from 127 Ϯ 18 to 122 Ϯ 26 g/m 2 , n ϭ 33, P Ͻ 0.001) in 2 yr. Those with normal initial LVMi values exhibited an increase in LVMi (from 93 Ϯ 16 to 99 Ϯ 21 g/m 2 , n ϭ 84, P Ͻ 0.001); however, the changes were not related to [Hb]. The difference in the changes in LVMi in 2 yr between patients with and without LVH in baseline assessments was also significant (Ϫ3.9 Ϯ 19 versus 7.0 Ϯ 19 g/m 2 , P ϭ 0.006).…”

“…Many studies examining mortality and morbidity rates among patients with CKD have identified high rates of cardiovascular events. When even mild renal insufficiency is associated with other risk factors for cardiovascular disease, the risk of subsequent cardiovascular events is significantly increased (2)(3)(4)(5)(6)(7)(8)(9)(10). The effect of mild renal insufficiency (serum creatinine levels of Ͼ124 M) on cardiovascular risk is possibly also independent of other known risk factors and treatment (11)(12)(13)(14)(15).…”

Creatinine clearance and signs of end-organ damage in primary hypertension

“…In the Hypertension Detection and Follow-up Program trial, a linear relation between serum creatinine and cardiovascular mortality was observed over a 5-year follow-up, with a 2 times higher risk of mortality in patients with serum creatinine 41.7 mg/dl at baseline. 16 More recently, in the HOT study a slight increase in serum creatinine was associated with a 3.2 times greater incidence of fatal events, regardless of common cardiovascular risk factors. 7 Similar findings have also been reported by using creatinine clearance as an estimate of the glomerular filtration rate in patients with isolated systolic hypertension, 17 and in those with concomitant cardiovascular risk factors participating in the HOPE Study.…”

Preditores de insuficiência renal crônica em pacientes de centro de referência em hipertensão arterial

“…O tratamento da hipertensão arterial é uma das poucas medidas sabidamente efetivas em prolongar a sobrevida renal dos portadores de nefropatia das mais variadas etiologias 11,13 . Quanto maior o grau de proteinúria, mais intensamente a pressão arterial deve ser reduzida 9,10 .…”