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    Rate of Change in Renal Function and Mortality in Elderly Treated Hypertensive Patients

    Access Status
    Fulltext not available
    Authors
    Chowdhury, E.
    Langham, R.
    Ademi, Z.
    Owen, A.
    Krum, H.
    Wing, L.
    Nelson, M.
    Reid, Christopher
    Date
    2015
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Chowdhury, E. and Langham, R. and Ademi, Z. and Owen, A. and Krum, H. and Wing, L. and Nelson, M. et al. 2015. Rate of Change in Renal Function and Mortality in Elderly Treated Hypertensive Patients. Clinical Journal of the American Society of Nephrology. 10: pp. 1154-1161.
    Source Title
    Clinical Journal of the American Society of Nephrology
    Additional URLs
    http://cjasn.asnjournals.org/content/early/2015/04/21/CJN.07370714.short
    ISSN
    1555-9041
    School
    School of Public Health
    URI
    http://hdl.handle.net/20.500.11937/68524
    Collection
    • Curtin Research Publications
    Abstract

    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.

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