LAUSR

BACKGROUND Our objective of this study was to determine if rate of eGFR decline and its intensity was associated with cardiovascular risk and death in hypertensive patients whose baseline estimated glomerular filtration rate (eGFR) was higher than 60 mL/min/1.73m2. METHODS This study comprised 2,516 hypertensive patients who had had at least two serum creatinine measurements over a four-year period. An eGFR reduction of ≥10% per year has been deemed as high-eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end-points were: coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted. RESULTS 2,354 patients with low rate of eGFR decline and 149 with high-rate of eGFR decline were analyzed. The adjusted model shows that a -10% rate of eGFR decline per year is associated with a higher risk of the primary end-point (1.9; 95%CI1.1-3.5; p = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95%CI 1.2-4.2; p <0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were: serum creatinine (OR 3.35; p<0.001), gender, women (OR 15.3; p<0.001), tobacco user (OR 1.9; p<0.002) and pulse pressure (OR 0.99; p<0.05). CONCLUSIONS A rate of eGFR decline equal to or higher than -10% per year is a marker of CV risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.