title: Left-ventricular hypertrophy and renal outcome in hypertensive patients in primary-care.
abstract: BACKGROUND
  Subclinical cardiac damage has recently emerged as a potential predictor of adverse renal outcome. We therefore retrospectively evaluated the effect of left-ventricular hypertrophy (LVH), diagnosed electrocardiographically, on the renal outcome of hypertensive patients managed in primary care.
  
  
  METHODS
  From a historical cohort of 39,525 hypertensive individuals evaluated in 2005, we retrieved 5-year data of the 18,510 surviving subjects for whom renal follow-up was available.
  
  
  RESULTS
  The baseline prevalences of chronic kidney disease (CKD) and LVH in the study cohort were 25.6% and 5.6%, respectively. During the 5-year follow-up, 1.4% of patients with LVH and 0.5% of those without LVH progressed to end-stage renal disease (ESRD) requiring dialysis (P < 0.01). Moreover, 25.6% of patients with LVH and 17% without LVH progressed from each stage of CKD to a more advanced stage (P < 0.01), whereas 0.9% of patients with LVH and 0.4% without LVH reached stage 5 CKD (P < 0.01). Multivariate Cox regression analysis showed that besides estimated glomerular filtration rate (eGFR) and male gender, LVH was the most significant modifiable predictor of progression to dialysis (hazard ratio (HR), 1.82; 95% CI, 1.05-3.17; P = 0.03). Multivariate logistic regression analysis also revealed LVH as a significant predictor of the risk of progression from each stage of CKD to a more advanced stage (OR, 1.24; 95% CI, 1.07-1.45; P < 0.01), as well as of progression to stage 5 CKD (OR, 1.86; 95% CI, 1.17-2.95; P < 0.01).
  
  
  CONCLUSIONS
  Left-ventricular hypertrophy proved to be a significant predictor of adverse renal outcome in hypertensive patients managed with primary care, and systematic screening for LVH should be adopted for assessing renal risk in these patients.
authors: Division of Nephrology, Dialysis and Transplantation, Department of Internal Medicine, University of Genoa, IRCCS-Azienda Ospedaliera Universitaria San Martino-IST, Genoa, Italy.
authors: Maura
authors: M
authors: Ravera
authors: Giuseppe
authors: G
authors: Noberasco
authors: Alessio
authors: A
authors: Signori
authors: Michela
authors: M
authors: Re
authors: Alessandro
authors: A
authors: Filippi
authors: Rossella
authors: R
authors: Cannavò
authors: Ursula
authors: U
authors: Weiss
authors: Claudio
authors: C
authors: Cricelli
authors: Giacomo
authors: G
authors: Deferrari
authors: Ernesto
authors: E
authors: Paoletti
mesh_terms: D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011320:Primary Health Care; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies