Cardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate

Rahman, Mahboob; Pressel, Sara L.; Davis, Barry R.; Nwachuku, Chuke; Wright, Jackson T.; Barzilay, Joshua I.; Batuman, Vecihi; Eckfeldt, John H.; Farber, Michael A.; Franklin, Stanley S.; Henriquez, Mario; Kopyt, Nelson; Louis, Gail T.; Saklayen, Mohammad G.; Stanford, Carole; Walworth, Candace; Ward, Harry J.; Wiegmann, Thomas

doi:10.7326/0003-4819-144-3-200602070-00005

Cited by 197 publications

(162 citation statements)

References 30 publications

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“…The preponderance of evidence suggests that systolic blood pressure, rather than diastolic blood pressure, is the primary determinant of CKD progression. 8,29 However, data from the MDRD trial indicate that controlling mean arterial pressure, which is primarily determined by diastolic blood pressure, slows CKD progression in persons without diabetes. 30 The MDRD intervention group achieved a mean arterial pressure of 5.1 mm Hg less than in the control group, with a corresponding hazard ratio of 0.68 for the development of ESRD at 6 years of follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…Poorly controlled hypertension as either a cause or consequence of CKD predisposes to cardiovascular disease complications, as well as more rapid progression to ESRD. 7,8 In the United States, the incidence of ESRD from hypertensive CKD in African American men is 5 times that in white men and 1.4 times that in African American women. 9 African Americans with CKD have poorly controlled hypertension compared with whites with CKD, 10 but differences in hypertension control between African American men and other race/sex groups with CKD have not been well described.…”

Section: Index Wordsmentioning

confidence: 99%

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Race and Sex Differences in Hypertension Control in CKD: Results From the Kidney Early Evaluation Program (KEEP)

Duru¹,

Li²,

Jurkovitz

et al. 2008

American Journal of Kidney Diseases

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Section: Discussionmentioning

confidence: 99%

Section: Index Wordsmentioning

confidence: 99%

Race and Sex Differences in Hypertension Control in CKD: Results From the Kidney Early Evaluation Program (KEEP)

Duru¹,

Li²,

Jurkovitz

et al. 2008

American Journal of Kidney Diseases

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“…4 As a consequence, only a minority of the hundreds of thousands of patients with stages 3 and 4 CKD reach kidney failure. 5 Proteinuria also is an important prognostic factor in patients with CKD. Although patients with nonproteinuric CKD are at greater risk of cardiovascular mortality than progression to kidney failure, the opposite may be true for the presence of proteinuria.…”

Section: Index Wordsmentioning

confidence: 99%

“…More recently, evidence has been provided that RAASblocking agents also ameliorate glomerular sieving function by directly restoring slit diaphragm integrity and increasing negative charge on the glomerular membrane. 20 After the landmark trial on the use of captopril in diabetic kidney disease conducted by the Collaborative Study Group, 21 several clinical trials demonstrated that RAAS-blocking agents may effectively maximize reno-and cardioprotection 5,22 in both diabetic and nondiabetic nephropathies. 23-30…”

Section: Blood Pressure: the First "P" For Ckd Progressionmentioning

confidence: 99%

Blood Pressure, Proteinuria, and Phosphate as Risk Factors for Progressive Kidney Disease: A Hypothesis

Cozzolino

Gentile

Mazzaferro

et al. 2013

American Journal of Kidney Diseases

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Chronic kidney disease (CKD) affects approximately 500 million people worldwide and is increasingly common in both industrialized and emerging countries. Although the mechanisms underlying the inexorable progression of CKD are incompletely defined, recent discoveries may pave the way to a more comprehensive understanding of the pathophysiology of CKD progression and the development of new therapeutic strategies. In particular, there is accumulating evidence indicating a key role for the complex and yet incompletely understood system of divalent cation regulation, which includes phosphate metabolism and the recently discovered fibroblast growth factor 23 (FGF-23)/klotho system, which seems inextricably associated with vitamin D deficiency. The aim of this review is to discuss the links between high blood pressure, proteinuria, phosphate levels, and CKD progression and explore new therapeutic strategies to win the fight against CKD. Am J Kidney Dis. xx(x):xxx. © 2013 by the National Kidney Foundation, Inc. INDEX WORDS:Chronic kidney disease; vitamin D deficiency; blood pressure; proteinuria; phosphate.C hronic kidney disease (CKD) is a silent killer.Four of 5 people with advanced CKD are not aware of the disease until death is imminent and kidney replacement therapy (dialysis or kidney transplantation) is unavoidable. Unfortunately, Ͻ10% of people requiring replacement therapy have access to it, and more than 1 million people worldwide die of untreated kidney failure each year because dialysis or kidney transplantation is unaffordable in most countries. This represents a huge economic burden, with global costs from 2000-2010 surpassing $1 trillion. 1,2 Worsening kidney function is associated with a marked increase in cardiovascular morbidity and mortality 1,3 independent of other risk factors. Coexistent hypertension is present in ϳ80% of patients with CKD and worsens cardiovascular outcomes because only 64% of patients with CKD achieve adequate blood pressure control. 4 As a consequence, only a minority of the hundreds of thousands of patients with stages 3 and 4 CKD reach kidney failure. 5 Proteinuria also is an important prognostic factor in patients with CKD. Although patients with nonproteinuric CKD are at greater risk of cardiovascular mortality than progression to kidney failure, the opposite may be true for the presence of proteinuria. Patients from the REIN (Ramipril Efficacy in Nephropathy) Study who were in the highest tertile of baseline proteinuria (protein excretion Ն3.8 g/d) also experienced the highest rate of glomerular filtration rate (GFR) loss during followup. 6 In addition, although post hoc analysis of RENAAL (Reduction of Endpoints in NIDDM [Non-InsulinDependent Diabetes Mellitus] With the Angiotensin II Antagonist Losartan) showed that 85% of patients with proteinuria with protein excretion Ն3 g/d reached the composite end point of doubling of serum creatinine level or end-stage renal disease (ESRD), only 44% of these patients reached the composite cardiovascular outcome. 7 Besides the we...

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“…Table 2 (17-23) summarizes illustrative trials. Two of these studies cited differences in BP achieved as possible reasons for the increased stroke risk with ACEI therapy (18,19), although at least one trial reported that ACEI reduced stroke risk (21).…”

Section: Bp Controlmentioning

confidence: 99%

Stroke in Chronic Kidney Disease

Townsend¹

2008

Clinical Journal of the American Society of Nephrology

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Credit Designation Statement:The American Society of Nephrology designates this educational activity (entire supplement) for a maximum of 2.0 AMA PRA Category 1 Credits TM . Physicians should only claim credit commensurate with the extent of their participation in the activity. Study the education content, and complete the examination; 80% correct is required for full credit on first submission. Continuing medical education credit eligible through November 2008. Learning Objectives:1. To examine the epidemiology and pathophysiology of stroke and cardiovascular disease in the chronic kidney disease population 2. To evaluate the efficacy of current therapies for the treatment of cardiovascular risk in patients with renal disease 3. To apply new clinical insights for the identification and treatment of cardiovascular risk to improve outcomes for patients with chronic kidney disease Target audience: Physicians in internal medicine, nephrology, endocrinology, and other health care providers who are interested in the treatment of hypertension and kidney disease.Categories: Stroke prevention, angiotensin receptor blocker, angiotensin-converting enzyme inhibitor, kidney disease

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Cardiovascular Outcomes in High-Risk Hypertensive Patients Stratified by Baseline Glomerular Filtration Rate

Cited by 197 publications

References 30 publications

Race and Sex Differences in Hypertension Control in CKD: Results From the Kidney Early Evaluation Program (KEEP)

Race and Sex Differences in Hypertension Control in CKD: Results From the Kidney Early Evaluation Program (KEEP)

Blood Pressure, Proteinuria, and Phosphate as Risk Factors for Progressive Kidney Disease: A Hypothesis

Stroke in Chronic Kidney Disease

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