Rate of Change in Renal Function and Mortality in Elderly Treated Hypertensive Patients
MetadataShow full item record
Background and objectives Evidence relating the rate of change in renal function, measured as eGFR, after antihypertensive treatment in elderly patients to clinical outcome is sparse. This study characterized the rate of change in eGFR after commencement of antihypertensive treatment in an elderly population, the factors associated with eGFR rate change, and the rate's association with all-cause and cardiovascular mortality. Design, setting, participants, & measurements Data from the Second Australian National Blood Pressure study were used, where 6083 hypertensive participants aged =65 years were enrolled during 1995-1997 and followed for a median of 4.1 years (in-trial). Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). The annual rate of change in the eGFR was calculated in 4940 participants using creatinine measurements during the in-trial period and classified into quintiles (Q) on the basis of the following eGFR changes: rapid decline (Q1), decline (Q2), stable (Q3), increase (Q4), and rapid increase (Q5). Results A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. However, a rapid increase in eGFR was observed in younger women and those with a higher cholesterol level. After adjustment for baseline and in-trial covariates, Cox-proportional hazard models showed a significantly greater risk for both all-cause (hazard ratio, 1.28; 95% confidence interval, 1.09 to 1.52; P=0.003) and cardiovascular (hazard ratio, 1.40; 95% confidence interval, 1.11 to 1.76; P=0.004) mortality in the rapid decline group compared with the stable group over a median of 7.2 years after the last eGFR measure. No significant association with mortality was observed for a rapid increase in eGFR. Conclusions In elderly persons with treated hypertension, a rapid decline in eGFR is associated with a higher risk of mortality.
Showing items related by title, author, creator and subject.
Long-term survival following the development of heart failure in an elderly hypertensive population.Sahle, B.; Owen, A.; Wing, L.; Beilin, L.; Krum, H.; Reid, Christopher; Second Australian National Blood Pressure Study Management Committee (2017)Background: Available data on the prognosis of heart failure (HF) patients is predominantly limited to patients diagnosed at time of hospitalization. AIMS: To describe the long-term survival of incident HF patients and ...
Elevated Osteoprotegerin Predicts Declining Renal Function in Elderly Women: A 10-Year Prospective Cohort StudyLewis, J.; Lim, W.; Zhu, K.; Wong, G.; Dhaliwal, Satvinder; Lim, E.; Ueland, T.; Bollerslev, J.; Prince, R. (2014)Background: Elevated osteoprotegerin (OPG) levels are inversely correlated with creatinine clearance and end-stage renal disease in patients with diabetes, however its role in predicting decline in renal function and ...
Five-Year Decline in Estimated Glomerular Filtration Rate Associated With a Higher Risk of Renal Disease and Atherosclerotic Vascular Disease Clinical Events in Elderly WomenLim, W; Lewis, J; Wong, G; Dogra, G; Zhu, K; Lim, E; Dhaliwal, Satvinder; Prince, R (2013)Background: Estimated glomerular filtration rate (eGFR) has been demonstrated to predict atherosclerotic vascular disease (ASVD)-associated clinical events independent of traditional vascular risk factors. Recent studies ...