[Decreased glomerular filtration rate using the Cockckroft-Gault and MDRD formulas does not always predict cardiovascular morbidity and mortality in hypertensive primary care patients].
BACKGROUND
A decrease in renal function is associated with cardiovascular morbidity and mortality. The aim of this study was to analyse the association of cardiovascular morbidity and mortality with baseline glomerular filtration rate (GFR), calculated according to the Cockcroft-Gault and MDRD formulas, with the incidence of major adverse cardiovascular events (MACEs) in a cohort of hypertensive individuals followed for 12 years.


METHODS
We performed a prospective study of a random sample of 223 hypertensive patients free of MACEs, who were followed in an urban Primary Care Centre. GFR was estimated using both formulas. MACEs were considered as the onset of ischaemic heart disease, heart failure, heart attacks, peripheral vascular disease or cardiovascular death. Data were analysed using the life-table method and Cox regression modeling.


RESULTS
The median follow-up was 10.7 (interquartile range, 6.5-12.1) years. Follow-up was completed in 191 participants (85.7%). The cumulative survival was 64.7% (95% Confidence Interval (CI), 57.9-71.6). The incidence of MACEs during the follow-up period was 3.6 (95% CI, 2.7-4.4) per 100 subject-years. The final multivariable model showed that the most predictive variables of MACEs in the study population were the presence of diabetes mellitus and the estimation of GFR ≥60 ml/min/1.73 m2 by MDRD equation.


CONCLUSIONS
There was a relationship between the occurrence of MACEs and an estimated GFR by MDRD above 60 ml/min/1.73 m2 at study entry, inversely to what was expected. GFR estimated by the C-G formula was not associated with cardiovascular risk.
Equipo de Atención Primaria Martí i Julià, Cornellá, Barcelona. javiertovillas@yahoo.es
F J
FJ
Tovillas-Morán
M
M
Vilaplana-Cosculluela
A
A
Dalfó-Pibernat
E
E
Zabaleta-del-Olmo
J M
JM
Galcerán
A
A
Coca
A
A
Dalfó-Baqué
D000368:Aged; D000465:Algorithms; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D011320:Primary Health Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012494:Sampling Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D014505:Urban Population