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Sex differences in hypertension-related renal and cardiovascular diseases in Italy: the I-DEMAND study

Muiesan, Maria Lorenzaa; Ambrosioni, Ettorec; Costa, Francesco Vittorioc; Leonetti, Gastoned; Pessina, Achille Cesaree; Salvetti, Massimoa; Trimarco, Brunof; Volpe, Massimog; Pontremoli, Robertob; Deferrari, Giacomob; Rosei, Enrico Agabitia

doi: 10.1097/HJH.0b013e328359b6a9

Aim: The aim of this study is to evaluate the differences in the prevalence of chronic kidney disease (CKD) and of cardiovascular risk factors and diseases between men and women participating in the Italy Developing Education and awareness on MicroAlbuminuria in patients with hyperteNsive Disease (I-DEMAND) study.

Methods: This is an observational, cross-sectional, multicenter study aimed at assessing prevalence and correlates of CKD among Italian hypertensive patients attending out-patient referral clinics. CKD was defined as glomerular filtration rate (GFR) less than 60 ml/min per 1.73 m2 [Modification of Diet in Renal Disease (MDRD) study equation and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation] and/or urine albumin-to-creatinine ratio of at least 2.5 mg/mmol in men and of at least 3.5 mg/mmol in women or both. Left-ventricular hypertrophy (LVH) was diagnosed by either ECG or echocardiography.

Results: A total of 3558 study patients with renal data available were considered for this analysis: mean age was 61 ± 4 years and 37% had diabetes mellitus. Female patients (n = 1636, 46%) were older, with a greater prevalence of obesity and lower prevalence of smoking. The prevalence of concomitant coronary artery and peripheral artery diseases, but not of hypertension, diabetes mellitus, or heart failure, was lower in women than in men. The overall prevalence of albuminuria (21 vs. 32%; P = 0.001) and of microalbuminuria (16 vs. 23%; P = 0.001) was lower in women than in men. In women the prevalence of a reduced GFR estimated by both MDRD (33 vs. 21%; P = 0.001) and CKD-EPI equations (32 vs. 23%; P = 0.001) was higher than in men. CKD prevalence was similar in women and men (44 vs. 41%; P = 0.095 and 43 vs. 43%; P = 0.475, respectively, when MDRD and CKD-EPI eGFR estimations were used). The prevalence of LVH (diagnosed by either ECG or echocardiography) was similar in men and women (18 vs. 20%; P = 0.12).

The main independent determinants of CKD were age, glycemia, uricemia, pulse pressure, hypertension duration, and previous cardiovascular diseases in men, and increasing age, glycemia, uricemia, pulse pressure, and a lower BMI in women.

Conclusion: Renal abnormalities are present in a significant number of female hypertensive patients attending hypertension clinics. Prevalence of reduced eGFR and of microalbuminuria, associated risk factors, and clinical conditions are different between men and women, suggesting the need to develop specific therapeutic strategies to prevent renal dysfunction and reduce associated morbidity and mortality.

aDepartment of Internal Medicine, University of Brescia, Brescia

bDepartment of Internal Medicine, University of Genoa and IRCCS AziendaOspedalieraUniversitaria San Martino-IST, Genoa

cDepartment of Internal Medicine, University of Bologna, Bologna

dIstituto Auxologico Italiano, Ospedale S.Luca, Milan

eDepartment of Clinical and Experimental Medicine, University of Padua, Padua

fDepartment of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples

gCardiology Division, Department of Clinical and Molecular Medicine, University of Rome ‘Sapienza’, Rome, and IRCCS Neuromed, Pozzilli (IS), Italy

Correspondence to Professor Enrico Agabiti Rosei, Clinica Medica – Department of Internal Medicine, University of Brescia – Spedali Civili Brescia, Brescia, Italy. Tel: +39 0303995251; fax: +39 0303388147; e-mail:

Abbreviations: ACR, albumin creatinine ratio; CKD, chronic kidney disease; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; HDL, high-density lipoprotein; LDL, low-density lipoprotein; LVH, left-ventricular hypertrophy; MDRD, Modification of Diet in Renal Disease; PP, pulse pressure

Received 22 March, 2012

Revised 31 July, 2012

Accepted 24 August, 2012

© 2012 Lippincott Williams & Wilkins, Inc.