title: Cardiovascular risk factor treatment targets and renal complications in high risk vascular patients: a cohort study.
abstract: BACKGROUND
  To determine if recommended treatment targets, as specified in clinical practice guidelines for the management of cardiovascular disease, reduces the risk of renal complications in high risk patient populations.
  
  
  METHODS
  This was a cohort study. Participants in Utrecht, The Netherlands either at risk of, or had cardiovascular disease were recruited. Cardiovascular treatment targets were achievement of control in systolic and diastolic blood pressure, total and low-density cholesterol, and treatment of albuminuria. Outcome measures were time to development of end stage renal failure or symptomatic renal atherosclerotic disease requiring intervention.
  
  
  RESULTS
  The cohort consisted of 7,208 participants; 1,759 diabetics and 4,859 with clinically manifest vascular disease. The median age was 57 years and 67% were male. Overall, 29% of the cohort achieved the treatment target for systolic blood pressure, 39% for diastolic blood pressure, 28% for total cholesterol, 31% for LDL cholesterol and 78% for albuminuria. The incidence rate for end stage renal failure and renal atherosclerotic disease reduced linearly with each additional treatment target achieved (p value less than 0.001). Achievement of any two treatment targets reduced the risk of renal complications, hazard ratio 0.46 (95% CI 0.26-0.82). For patients with clinically manifest vascular disease and diabetes, the hazard ratios were 0.56 (95% CI 0.28 - 1.12) and 0.28 (95%CI 0.10 - 0.79) respectively.
  
  
  CONCLUSIONS
  Clinical guidelines for cardiovascular disease management do reduce risk of renal complications in high risk patients. Benefits are seen with attainment of any two treatment targets.
authors: Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia. s.selvarajah@umcutrecht.nl
authors: Sharmini
authors: S
authors: Selvarajah
authors: Yolanda
authors: Y
authors: van der Graaf
authors: Frank L J
authors: FL
authors: Visseren
authors: Michiel L
authors: ML
authors: Bots
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000150:complications* / Q000628:therapy*; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000150:complications / Q000628:therapy; D007674:Kidney Diseases / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome