title: Prognostic value of combined target-organ damage in patients with essential hypertension.
abstract: BACKGROUND
  Whether the combination of chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) affects the cardiovascular (CV) risk in patients with uncomplicated hypertension is poorly investigated. The aim of this study was to assess the effects of LVH, CKD, and their combination on CV events in hypertension.
  
  
  METHODS
  This study analyzed 1,078 patients with essential hypertension.
  
  
  RESULTS
  LVH was present in 104 (9.6%) patients, CKD was present in 556 (51.5%) patients, and the combination of LVH and CKD was found in 174 (16.1%) patients. During the follow-up (median = 84 months), 52 CV events were observed (0.64 events/100 patient-years): 6 (2.4%) in patients without target-organ damage (TOD), 6 (5.7%) in patients with LVH, 20 (3.6%) in patients with CKD, and 20 (11.4%) in patients with combined LVH+CKD. Adjusted hazard ratio (HR) for CV events was 1.62 (P = 0.34) for LVH, 0.951 (P = 0.94) for CKD, and 2.45 (P = 0.03) for LVH+CKD. After multivariable Cox proportional hazard analysis, the combination of LVH+CKD was significantly associated with risk of CV events, when the model was adjusted for sex and age (HR = 2.447; P = 0.03) and for the presence of 1 CV risk factor (HR = 3.226; P = 0.02). In contrast, the association of LVH+CKD was no longer significant when the model was adjusted for sex, age, and the presence of ≥ 2 CV risk factors.
  
  
  CONCLUSIONS
  The results of this study highlight the relevance of the interactions between TODs and hemodynamic, anthropometric, and metabolic abnormalities in the CV risk stratification of patients with essential hypertension.
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Gerardo
authors.initials: G
authors.lastname: Carpinella
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Gennaro
authors.initials: G
authors.lastname: Pagano
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Francesco
authors.initials: F
authors.lastname: Buono
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Marta
authors.initials: M
authors.lastname: Petitto
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Giovanna
authors.initials: G
authors.lastname: Guarino
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Orefice
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.affiliation: Dipartimento di Scienze Biomediche Avanzate, Università Federico II, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Dipartimento Scienze Mediche Traslazionali, Università Federico II, Naples, Italy; carmine.morisco@unina.it.
authors.forename: Carmine
authors.initials: C
authors.lastname: Morisco
mesh_terms: D000328:Adult; D000367:Age Factors; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006339:Heart Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
chemical_list: D000959:Antihypertensive Agents
keywords: blood pressure; cardiovascular risk; chronic kidney disease; essential hypertension; hypertension; left ventricular hypertrophy; myocardial infarction; stroke