Objective: Presence of hypertensive target organ damage is related to increased vascular risk and mortality. Whether combined presence of hypertensive target organ damage confers higher vascular risk compared to single presence is unknown. This study evaluates the separate and combined effects of impaired renal function [estimated glomerular filtration rate (eGFR) ≤60 ml/min per 1.73 m2], albuminuria (albumin/creatinine-ratio men ≥2.5 mg/mmol, women ≥3.5 mg/mmol) and left-ventricular hypertrophy (LVH) (Sokolow–Lyon and/or Cornell-voltage criterion) on the occurrence of vascular events and mortality in patients with vascular disease (coronary artery disease, cerebrovascular disease, and peripheral arterial disease).
Methods and results: A cohort of patients with vascular diseases (n = 4319) was followed (median 4.4 years) for the occurrence of vascular events (stroke, myocardial infarction, vascular death) and mortality. LVH was present in 11%, impaired renal function in 15%, and albuminuria in 18%. Presence of at least two hypertensive target organ damage was prevalent in 8%. The risk for vascular events was hazard ratio 1.5 [95% confidence interval (CI) 1.2–1.9] for presence of one hypertensive target organ damage and hazard ratio 3.8 (95% CI 2.3–6.3) for three manifestations of hypertensive target organ damage (adjusted for age, sex). For mortality this was hazard ratio 1.4 (95% CI 1.1–1.7) and hazard ratio 3.2 (95% CI 1.9–5.2). Hazard ratios for single presence of different types of organ damage were comparable and independent of the presence of hypertension.
Conclusions: Impaired renal function, albuminuria, and LVH are prevalent in patients with vascular disease and confer independent and additive risk for vascular events and mortality. Measurement of hypertensive target organ damage in patients with vascular disease identifies patients at very high risk and may have treatment implications.
aDepartment of Vascular Medicine
bJulius Center for Health Sciences and Primary Care
cDepartment of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
Correspondence to Wilko Spiering, MD, PhD, Department of Vascular Medicine, F02.126, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands. Tel: +31 88 7555555; fax: +31 88 7555488; e-mail: W.Spiering@umcutrecht.nl
Abbreviations: CAD, coronary artery disease; CVD, cerebrovascular disease; eGFR, estimated glomerular filtration rate; IMT, intima–media thickness; LVH, left-ventricular hypertrophy; MDRD, Modification of Diet in Renal Disease; RAAS, renin–angiotensin–aldosterone system; SCORE, Systematic COronary Risk Evaluation; SMART, Second Manifestations of ARTerial disease
Received 15 March, 2012
Revised 22 October, 2012
Accepted 20 November, 2012