title: Left ventricular hypertrophy versus chronic kidney disease as predictors of cardiovascular events in hypertension: a Greek 6-year-follow-up study.
abstract: OBJECTIVE
  We assessed the comparative prognostic role of left ventricular hypertrophy (LVH) and chronic kidney disease (CKD) for major cardiovascular events in a prospective observational study in Greek essential hypertensive patients.
  
  
  METHODS
  We followed up 1652 hypertensive patients (mean age 54.3 years, 696 male patients, office blood pressure 147/93 mmHg) free of cardiovascular disease for a mean period of 6 years. CKD and echocardiographically detected LVH were evaluated at baseline along with five major traditional risk factors [age > 65 years, sex, current smoking, diabetes mellitus and dyslipidemia (low density lipoprotein > 160 mg/dl)]. End points of interest were the incidence of coronary artery disease, stroke, all-cause mortality and their composite.
  
  
  RESULTS
  At the end of follow-up, coronary artery disease was the most prevalent (5.2%), followed by stroke (5%) and total mortality (3.1%). The presence of both LVH and CKD is associated with a 2.5-fold increase in coronary artery disease (P = 0.034), four-fold in stroke (P = 0.002) and 3.2-fold in the composite (P < 0.001), whereas the presence of LVH alone was associated with a 2.5-fold higher risk for stroke (P = 0.009) and 1.7-fold for the composite (P = 0.018). By multivariate Cox regression analysis, LVH (hazard ratio = 1.53, P = 0.036) and CKD (hazard ratio = 1.66, P = 0.039) turned out to be independent prognosticators of the composite end point, whereas age more than 65 years (hazard ratio = 4.59, P < 0.001) and the presence of LVH (hazard ratio = 2.01, P = 0.043) were the only predictors of stroke.
  
  
  CONCLUSIONS
  In hypertensive patients free of cardiovascular disease, CKD and LVH are both independent prognosticators of the composite end point of all-cause death and cardiovascular morbidity, whereas LVH but not CKD is a major predictor for stroke.
authors.affiliation: First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece. ktsioufis@hippocratio.gr
authors.forename: Costas
authors.initials: C
authors.lastname: Tsioufis
authors.forename: Elena
authors.initials: E
authors.lastname: Vezali
authors.forename: Dimitris
authors.initials: D
authors.lastname: Tsiachris
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Dimitriadis
authors.forename: Eystathios
authors.initials: E
authors.lastname: Taxiarchou
authors.forename: Dimitris
authors.initials: D
authors.lastname: Chatzis
authors.forename: Costas
authors.initials: C
authors.lastname: Thomopoulos
authors.forename: Dimitris
authors.initials: D
authors.lastname: Syrseloudis
authors.forename: Elli
authors.initials: E
authors.lastname: Stefanadi
authors.forename: Costas
authors.initials: C
authors.lastname: Mihas
authors.forename: Vicky
authors.initials: V
authors.lastname: Katsi
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papademetriou
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D007674:Kidney Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models