Left ventricular hypertrophy versus chronic kidney disease as predictors of cardiovascular events in hypertension: a Greek 6-year-follow-up study.
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.
Tsioufis
Costas
C
First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece. ktsioufis@hippocratio.gr
Vezali
Elena
E
Tsiachris
Dimitris
D
Dimitriadis
Kyriakos
K
Taxiarchou
Eystathios
E
Chatzis
Dimitris
D
Thomopoulos
Costas
C
Syrseloudis
Dimitris
D
Stefanadi
Elli
E
Mihas
Costas
C
Katsi
Vicky
V
Papademetriou
Vasilios
V
Stefanadis
Christodoulos
C
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