title: Risk stratification by 24-hour ambulatory blood pressure and estimated glomerular filtration rate in 5322 subjects from 11 populations.
abstract: No previous study addressed whether in the general population estimated glomerular filtration rate (eGFR [Chronic Kidney Disease Epidemiology Collaboration formula]) adds to the prediction of cardiovascular outcome over and beyond ambulatory blood pressure. We recorded health outcomes in 5322 subjects (median age, 51.8 years; 43.1% women) randomly recruited from 11 populations, who had baseline measurements of 24-hour ambulatory blood pressure (ABP(24)) and eGFR. We computed hazard ratios using multivariable-adjusted Cox regression. Median follow-up was 9.3 years. In fully adjusted models, which included both ABP(24) and eGFR, ABP(24) predicted (P≤0.008) both total (513 deaths) and cardiovascular (206) mortality; eGFR only predicted cardiovascular mortality (P=0.012). Furthermore, ABP(24) predicted (P≤0.0056) fatal combined with nonfatal events as a result of all cardiovascular causes (555 events), cardiac disease (335 events), or stroke (218 events), whereas eGFR only predicted the composite cardiovascular end point and stroke (P≤0.035). The interaction terms between ABP(24) and eGFR were all nonsignificant (P≥0.082). For cardiovascular mortality, the composite cardiovascular end point, and stroke, ABP(24) added 0.35%, 1.17%, and 1.00% to the risk already explained by cohort, sex, age, body mass index, smoking and drinking, previous cardiovascular disease, diabetes mellitus, and antihypertensive drug treatment. Adding eGFR explained an additional 0.13%, 0.09%, and 0.14%, respectively. Sensitivity analyses stratified for ethnicity, sex, and the presence of hypertension or chronic kidney disease (eGFR <60 mL/min per 1.73 m(2)) were confirmatory. In conclusion, in the general population, eGFR predicts fewer end points than ABP(24). Relative to ABP(24), eGFR is as an additive, not a multiplicative, risk factor and refines risk stratification 2- to 14-fold less.
authors.affiliation: Centro de Nefrología and Departamento de Fisiopatología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
authors.forename: José
authors.initials: J
authors.lastname: Boggia
authors.forename: Lutgarde
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authors.lastname: Thijs
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Tine W
authors.initials: TW
authors.lastname: Hansen
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Kristina
authors.initials: K
authors.lastname: Björklund-Bodegård
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Jørgen
authors.initials: J
authors.lastname: Jeppesen
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.forename: Eamon
authors.initials: E
authors.lastname: Dolan
authors.forename: Tatiana
authors.initials: T
authors.lastname: Kuznetsova
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Stolarz-Skrzypek
authors.forename: Valérie
authors.initials: V
authors.lastname: Tikhonoff
authors.forename: Sofia
authors.initials: S
authors.lastname: Malyutina
authors.forename: Edoardo
authors.initials: E
authors.lastname: Casiglia
authors.forename: Yuri
authors.initials: Y
authors.lastname: Nikitin
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Emma
authors.initials: E
authors.lastname: Schwedt
authors.forename: Edgardo
authors.initials: E
authors.lastname: Sandoya
authors.forename: Kalina
authors.initials: K
authors.lastname: Kawecka-Jaszcz
authors.forename: Jan
authors.initials: J
authors.lastname: Filipovsky
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Jiguang
authors.initials: J
authors.lastname: Wang
authors.forename: Hans
authors.initials: H
authors.lastname: Ibsen
authors.forename: Eoin
authors.initials: E
authors.lastname: O'Brien
authors.forename: Jan A
authors.initials: JA
authors.lastname: Staessen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis