[Diminished glomerular filtration rate as a marker of chronic kidney disease in hypertensive patients].
Recent guidelines of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) for the management of arterial hypertension (AH) have recognized the importance of renal function impairment on cardiovascular (CV) prognosis in patients with this condition. Chronic kidney disease (CKD) is associated with increased risk of CV risk and end-stage renal disease (ESRD) particularly among patients with AH.


OBJECTIVE
Our aims were to assess the frequency of CKD according to assessed values of glomerular filtration rate (GFR) in patients with essential AH and distribution of traditional risk factors of cardiovascular diseases in this population.


METHODS
The study was performed in 749 consecutive hospitalized patients with diagnosed and treated essential AH. All patients were subjected to complete history, physical examination and laboratory studies including lipid profile, fasting glucose and creatinine concentration. We estimated GFR using abbreviated MDRD (Modification of Diet in Renal Disease) formula. According to K/DOQI (Dialysis Outcome Quality Initiative), CKD was defined as GFR below 60 ml/min/1.73m2.


RESULTS
Mean age in studied group was 68.8 years (57.8% female). CKD diagnosed according to estimated GFR was found in 314 patients (42%). Women more likely (71%) fulfilled criteria for CKD in studied group. Patients with CKD were significantly more likely to be older, to have atherogenic dyslipidemia and a history of cardiovascular diseases (coronary heart disease, prior myocardial infarction, heart failure) (p < 0.01).


CONCLUSIONS
According to the ESH/ESC guidelines, CKD among AH patients is associated with high risk of CV complications and ESRD. This group of AH patients requires a integrative therapeutic strategy including optimal blood pressure control together with modification of traditional cardiovascular risk factors and treatment of established CV diseases. To identify this high risk population the systematic assessment of GFR and other CV factors should be done in every case of AH, especially in older and female patients.
Grabysa
Radosław
R
Szpital Wojskowy w Olsztynie, Oddział Chorób Wewnetrznych. rgraby@wp.pl
Cholewa
Marian
M
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology; D015897:Comorbidity; D050171:Dyslipidemias / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D012307:Risk Factors; D017678:Sex Distribution