Clinical profile and management of hypertensive patients with chronic ischemic heart disease and renal dysfunction attended by cardiologists in daily clinical practice

Barrios, Vivencio; Escobar, Carlos; Murga, Nekane; Pablo, Carmen de; Bertoméu, Vicente; Calderón, Alberto; Echarri, Rocio

doi:10.1097/hjh.0b013e328311cdee

Cited by 19 publications

(12 citation statements)

References 32 publications

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“…33 In two other studies examining adult patients with diabetes, albuminuria was found in 20.4-48.6% and reduced eGFR in 27.5 and 38%. 34,35 Moreover, Barrios et al 36 found GFR less than 60 mL/min/1.73 m 2 in 24.6% of patients with hypertension and chronic ischemic heart disease. It should be underlined that all these studies where a high prevalence of CKD in persons at risk of CKD was found, including our study, showed that most or even all patients with detected markers for CKD denied any knowledge of their kidney disease.…”

Section: Discussionmentioning

confidence: 99%

Screening of a Population at Risk of Chronic Kidney Disease: Analysis of Factors Associated with Low eGFR and Microalbuminuria

Ležaić¹,

Dimković²,

Peković³

et al. 2011

Renal Failure

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Background and objective: Numerous screenings of chronic kidney disease (CKD) have been performed all over the world. This screening study was undertaken with the aim of estimating the prevalence of low glomerular filtration rate (eGFR) and microalbuminuria (MAU) and/or proteinuria in a population at risk for CKD and to detect factors associated with these CKD markers. Materials and methods: This cross-sectional study included 1617 patients without previously known kidney disease who came for regular check-ups to their general practitioners in 13 Belgrade health centers over a 3-month period. Patients selected were as follows: 1316 with hypertension, 208 with type 2 diabetes, and 93 older than 60 years without hypertension or diabetes. Screening included a questionnaire, blood pressure measurement, single MAU dipstick measurement (Micral-test ® strip) and proteinuria and GFR estimation by Modification of Diet in Renal Disease. Results: MAU was found in 419 (25.9%) patients, proteinuria in 163 (10.1%), and eGFR < 60 mL/min/1.73 m 2 in 370 (22.9%). Multivariate logistic regression analysis revealed that female gender, age, duration of hypertension, and smoking were associated with eGFR. Male gender, hypertension, treatment with angiotensinconverting enzyme inhibitors, proteinuria, and systolic blood pressure were associated with MAU. Conclusions: High prevalence of MAU/proteinuria and reduced eGFR were found in high-risk persons for CKD. Besides nonmodifiable, significant modifiable factors for MAU were use of angiotensin-converting enzyme inhibitors and strict regulation of hypertension and the factor for reduced eGFR was smoking.

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Section: Discussionmentioning

confidence: 99%

Screening of a Population at Risk of Chronic Kidney Disease: Analysis of Factors Associated with Low eGFR and Microalbuminuria

Ležaić¹,

Dimković²,

Peković³

et al. 2011

Renal Failure

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“…These findings suggest that cardiorenal scintigraphy may be useful in a wide range of clinical conditions requiring a combined evaluation of heart and kidney, such as arterial hypertension, diabetes, chronic heart or renal failure, and heart or renal transplantations (1)(2)(3)(4)(5)(6)(7)(8)21). In addition, it may contribute valuable information to the diagnosis and functional evaluation of renovascular forms that are frequently associated with cardiovascular disease (22).…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have focused on this relationship as a link to cardiovascular risk and prognosis (1)(2)(3)(4)(5)(6)(7)(8), and the term cardiorenal syndrome is increasingly used to define a condition of reciprocal dysfunction of the heart and kidney, with different clinical presentations depending on which organ is primarily involved (1).…”

Section: Discussionmentioning

confidence: 99%

“…Mild renal dysfunction is known to be an independent risk factor with a strong prognostic significance in heart failure, arterial hypertension, and diabetes mellitus (2)(3)(4)(5)(6). On the other hand, cardiovascular disease has a high prevalence in nephropathic patients, and subclinical abnormalities of coronary reserve may be found in subjects with asymptomatic renal disease, suggesting a combined microvascular involvement of the kidney and the heart (7,8).…”

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confidence: 99%

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Single-Shot Cardiorenal Scintigraphy with ^99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion

Fommei

Bruselli²,

Ripoli³

et al. 2009

J Nucl Med

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Renal function is known to be a strong predictor of cardiovascular prognosis, and cardiorenal disease is increasingly investigated in medical research. In this study, we tested the hypothesis that a single combined cardiorenal scintigraphy examination with the perfusion tracer 99m Tc-tetrofosmin is feasible and may allow the simultaneous investigation of cardiac and renal pathology in cardiovascular patients. Methods: Thirty patients scheduled for dual-day gated SPECT also gave their informed consent for a renal acquisition after a single injection of 370 MBq of 99m Tc-tetrofosmin, at rest (30 patients) or with adenosine (21 patients), and to undergo an additional standard renal study with the glomerular tracer 99m Tc-diethylenetriaminepentaacetic acid (DTPA) (74 MBq) after 1 wk (24 patients). Kidney images and renograms were obtained. Renal uptake index, expressed as the percentage ratio of kidney counts cumulated over the second minute after injection to the administered dose, was calculated as a functional renal parameter. Time to peak activity and separate kidney percentage uptake (as the percentage contribution of each kidney to total renal uptake) were also calculated. Results: Compared with 99m Tc-DTPA, 99m Tctetrofosmin provided better-quality kidney images, with a higher uptake index (13.17% 6 4.76% vs. 8.33% 6 2.45%, P , 0.001) and with comparable separate kidney percentage uptake and times to peak activity. 99m Tc-tetrofosmin uptake index was significantly lower in the patients who were more compromised according to renal and cardiovascular functional parameters, and correlated with 99m Tc-DTPA uptake index (r 5 0.77, P , 0.001), serum creatinine (r 5 0.59, P , 0.005), log brain natriuretic peptide N-terminal levels (r 5 20.65, P , 0.005), myocardial and carotid intima-media wall thickness (for both, r 5 20.61, P , 0.005), and the Doppler index of renal vascular resistance (r 5 20.60, P , 0.005). In the 21 patients who underwent the provocative test, adenosine induced a significant decrease in renal 99m Tc-tetrofosmin uptake index (from 14.12% 6 4.50% to 11.81% 6 3.33%, P , 0.005) suggesting a decrement in renal perfusion or function. Conclusion: 99m Tc-tetrofosmin cardiorenal scintigraphy is feasible at low cost as a single-shot study and may allow both the evaluation of renal morphology and renograms during a cardiac study and the calculation of renal functional parameters.

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“…Thus, in a study involving 2024 patients with hypertension and chronic ischemic heart disease, those patients with an estimated glomerular filtration rate (using the Modification of Diet in Renal Disease study formula) ,60 mL/minute per 1.73 m 2 of body surface area (n = 666; 32.9%) were older and had a higher proportion of atrial fibrillation, diabetes, organ damage (left ventricular hypertrophy), associated clinical conditions (heart failure, cerebrovascular disease), and worse blood pressure (BP) control rates. 15 The diagnosis of hypertension-induced renal damage in hypertensives is based not only on reduced renal function but also on increased urinary excretion of albumin. 11 This is very relevant, as it is well established that any degree of albuminuria is associated with a higher risk of cardiovascular disease and progression of kidney disease.…”

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confidence: 99%

Emerging drug combinations to optimize renovascular protection and blood pressure goals

Escobar

Echarri²,

Barrios³

2012

IJNRD

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Hypertension and renal disease are closely related. In fact, there is an inverse linear relationship between renal function and prevalence of hypertension. Hypertensive patients with renal dysfunction exhibit a poor clinical profile, which markedly increases their risk for cardiovascular outcomes. This review considers the available evidence on the best therapeutic approach for optimizing renovascular protection in the hypertensive population. To effectively reduce or at least slow the establishment and progression of renal disease in the hypertensive population it is critical to reach blood pressure targets. Many studies have shown that angiotensinconverting enzyme inhibitors and angiotensin receptor blockers prevent or at least delay the development of microalbuminuria in patients with hypertension and type 2 diabetes, reduce the incidence of overt diabetic nephropathy, and are also beneficial in patients with nondiabetic renal disease. Therefore, renin-angiotensin system (RAS) inhibition plays a key role in the prevention of renal outcomes. As the majority of patients with hypertension will need at least two antihypertensive agents to achieve blood pressure goals, the use of RAS inhibitors is a mandatory part of antihypertensive therapy. The question of which antihypertensive agent is the best choice for combining with RAS blockers should be considered. Many studies have shown that diuretics and calcium channel blockers are the best choice. However, more studies are needed to clarify the subgroups of patients who will benefit more from a combination with a diuretic or from a combination with a calcium channel blocker. To date, RAS inhibitors recommended in this context are angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Aliskiren, the first oral direct renin inhibitor available, has shown promising results. Keywords: antihypertensive drugs, renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, combined therapy Hypertension and renal diseaseHypertension is the most important modifiable risk factor for cardiovascular disease. It has been estimated that about 30% of the general population is hypertensive, a proportion that increases to two-thirds in the elderly.1 Remarkably, this prevalence is increased in patients with renal insufficiency. Thus, in a large cohort of Spanish patients enrolled in an ongoing prospective, observational, multicenter study of patients with stage 3 (n = 434) and 4 (n = 695) chronic kidney disease, hypertension was almost universal (91.2% and 94.1%, respectively). Moreover, proteinuria (.300 mg/day) was present in more than 60% of patients, without significant differences between stages 3 and 4 (1.2 ± 1.8 and 1.3 ± 1.8 g/day, respectively).2 In fact, there is an inverse linear relationship between renal function and prevalence of hypertension (from 66% at a glomerular filtration rate of 83 mL/minute per 1.73 m 2 of body surface area to 95% at

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Clinical profile and management of hypertensive patients with chronic ischemic heart disease and renal dysfunction attended by cardiologists in daily clinical practice

Cited by 19 publications

References 32 publications

Screening of a Population at Risk of Chronic Kidney Disease: Analysis of Factors Associated with Low eGFR and Microalbuminuria

Screening of a Population at Risk of Chronic Kidney Disease: Analysis of Factors Associated with Low eGFR and Microalbuminuria

Single-Shot Cardiorenal Scintigraphy with ^99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion

Emerging drug combinations to optimize renovascular protection and blood pressure goals

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Clinical profile and management of hypertensive patients with chronic ischemic heart disease and renal dysfunction attended by cardiologists in daily clinical practice

Cited by 19 publications

References 32 publications

Screening of a Population at Risk of Chronic Kidney Disease: Analysis of Factors Associated with Low eGFR and Microalbuminuria

Screening of a Population at Risk of Chronic Kidney Disease: Analysis of Factors Associated with Low eGFR and Microalbuminuria

Single-Shot Cardiorenal Scintigraphy with 99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion

Emerging drug combinations to optimize renovascular protection and blood pressure goals

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Product

Resources

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Single-Shot Cardiorenal Scintigraphy with ^99mTc-Tetrofosmin: A Dynamic Characterization at Rest and During Adenosine Infusion