Left ventricular hypertrophy and renal dysfunction during antihypertensive treatment adversely affect cardiovascular prognosis in hypertensive patients

OBJECTIVES: Renal dysfunction is associated with an increased risk of cardiovascular events in hypertensive patients. Chronic kidney disease (CKD) and left ventricular hypertrophy (LVH) are both independent prognostic factors for cardiovascular events. The relation between changes in renal function and/or cardiac structure with subsequent prognosis has not yet been definitely assessed, and the aim of this study was to evaluate the relationships between renal and cardiac target-organ damage not only at baseline but also during treatment, and their influence on cardiovascular prognosis in hypertensive patients. METHODS: Among 436 uncomplicated hypertensive individuals, 246 with a baseline and follow-up (last examination 68 ± 34 months apart) echocardiogram and creatinine measurements were followed for an additional 55 ± 29 months. All patients received treatment by their family doctor. After the last follow-up echocardiogram, a first major cardiovascular event occurred in 54 patients. RESULTS: By multivariate Cox regression analysis, persistence and development of LVH from baseline to follow-up [adjusted hazard ratio 2.36, 95% confidence interval (CI) 1.03-3.68, P = 0.041] and persistence/development of CKD (estimated glomerular filtration rate according to the Modification of Diet in Renal Disease formula <60 ml/min) (adjusted hazard ratio 1.94, 95% CI 1.12-3.87, P = 0.021) from baseline to follow-up were identified as independent predictors of cardiovascular events. CONCLUSION: This study indicates that in hypertensive patients free of cardiovascular disease, both persistence or development of a reduced renal function and of LVH represent independent prognostic factors of cardiovascular events.