title: Low glomerular filtration rate, recurrent stroke risk, and effect of renin-angiotensin system modulation.
abstract: OBJECTIVE
  To investigate the association of low estimated glomerular filtration rate (eGFR) <60 mL/min with recurrent stroke risk and to evaluate whether add-on renin-angiotensin system modulator therapy is associated with lower recurrent stroke risk in patients with low eGFR.
  
  
  METHODS
  We analyzed the database of a multicenter trial involving 18,666 patients with recent ischemic stroke followed for 2.5 years. Primary outcome was time to first recurrent stroke. Independent associations of low eGFR with outcome in the entire cohort and add-on telmisartan treatment with outcome among those with low eGFR were evaluated.
  
  
  RESULTS
  Low eGFR was observed in 3630 (20.1%) patients. Patients with low eGFR were older, more likely women, with a known history of hypertension. In unadjusted analyses, patients with low eGFR were more likely to experience a recurrent stroke (hazard ratio, 1.34; 95% confidence interval, 1.20-1.49). After adjusting for confounders, low eGFR was still associated with recurrent stroke but to a lesser extent (hazard ratio, 1.16; 95% confidence interval, 1.04-1.31). Telmisartan treatment among patients with low eGFR was not independently associated with recurrent stroke (hazard ratio, 1.08; 95% confidence interval, 0.89-1.31).
  
  
  CONCLUSIONS
  Low eGFR is independently associated with a higher risk of recurrent stroke, but short-term add-on telmisartan therapy does not seem to mitigate this risk.
  
  
  BACKGROUND
  http://www.clinicaltrials.gov. Unique identifier: NCT00153062.
authors.affiliation: From the Department of Neurosciences, Medical University of South Carolina, Charleston, SC (B.O.); Stroke Trials Unit, University of Nottingham, United Kingdom (P.M.B.); Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT (D.C., N.S.); and Department of Neurology, University of Duisburg-Essen, Essen, Germany (H.-C.D.).
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.forename: Philip M
authors.initials: PM
authors.lastname: Bath
authors.forename: Daniel
authors.initials: D
authors.lastname: Cotton
authors.forename: Nanshi
authors.initials: N
authors.lastname: Sha
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001565:Benzoates / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D012084:Renin-Angiotensin System / Q000502:physiology*; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology; D000077333:Telmisartan; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001562:Benzimidazoles; D001565:Benzoates; D000077333:Telmisartan
keywords: glomerular filtration rate; myocardial infarction; prognosis; renal insufficiency, chronic; renin–angiotensin system; telmisartan