title: Rate of change in renal function and mortality in elderly treated hypertensive patients.
abstract: OBJECTIVE
  Evidence relating the rate of change in renal function, measured as eGFR, after antihypertensive treatment in elderly patients to clinical outcome is sparse. This study characterized the rate of change in eGFR after commencement of antihypertensive treatment in an elderly population, the factors associated with eGFR rate change, and the rate's association with all-cause and cardiovascular mortality.
  
  
  METHODS
  Data from the Second Australian National Blood Pressure study were used, where 6083 hypertensive participants aged ≥65 years were enrolled during 1995-1997 and followed for a median of 4.1 years (in-trial). Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). The annual rate of change in the eGFR was calculated in 4940 participants using creatinine measurements during the in-trial period and classified into quintiles (Q) on the basis of the following eGFR changes: rapid decline (Q1), decline (Q2), stable (Q3), increase (Q4), and rapid increase (Q5).
  
  
  RESULTS
  A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. However, a rapid increase in eGFR was observed in younger women and those with a higher cholesterol level. After adjustment for baseline and in-trial covariates, Cox-proportional hazard models showed a significantly greater risk for both all-cause (hazard ratio, 1.28; 95% confidence interval, 1.09 to 1.52; P=0.003) and cardiovascular (hazard ratio, 1.40; 95% confidence interval, 1.11 to 1.76; P=0.004) mortality in the rapid decline group compared with the stable group over a median of 7.2 years after the last eGFR measure. No significant association with mortality was observed for a rapid increase in eGFR.
  
  
  CONCLUSIONS
  In elderly persons with treated hypertension, a rapid decline in eGFR is associated with a higher risk of mortality.
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; enayet.chowdhury@monash.edu.
authors.forename: Enayet K
authors.initials: EK
authors.lastname: Chowdhury
authors.affiliation: Department of Nephrology and University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia;
authors.forename: Robyn G
authors.initials: RG
authors.lastname: Langham
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Melbourne EpiCentre, Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia;
authors.forename: Zanfina
authors.initials: Z
authors.lastname: Ademi
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
authors.forename: Alice
authors.initials: A
authors.lastname: Owen
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
authors.affiliation: School of Medicine, Flinders University, Adelaide, South Australia, Australia; and.
authors.forename: Lindon M H
authors.initials: LM
authors.lastname: Wing
authors.affiliation: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Nelson
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Reid
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001315:Australia; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects*; D003404:Creatinine / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D007668:Kidney / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D003404:Creatinine
keywords: elderly; glomerular filtration rate; hypertension; survival