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A Report From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

Mahboob Rahman, MD, MS; Clinton D. Brown, MD; Josef Coresh, MD, PhD; Barry R. Davis, MD; John H. Eckfeldt, MD, PhD; Nelson Kopyt, DO; Andrew S. Levey, MD; Chuke Nwachuku, MA, MPH; Sara Pressel, MS; Efrain Reisin, MD; Candace Walworth, MD; for the ALLHAT Collaborative Research Group

Arch Intern Med. 2004;164:969-976.

Background  The prevalence of reduced glomerular filtration rate (GFR) in older hypertensive patients and the relationship between level of GFR and cardiovascular disease (CVD) and its risk factors are not well known.

Methods  We evaluated baseline renal function in 40 514 hypertensive patients 55 years or older who were enrolled in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). We used the simplified Modification of Diet in Renal Disease study equation to estimate GFR and examined the prevalence of CVD in patients with different levels of GFR.

Results  Fifty-seven percent of patients had mild (60-89 mL/min per 1.73 m²), 17.2% had moderate (30-59 mL/min per 1.73 m²), and 0.6% had severe (29 mL/min per 1.73 m²) reductions in GFR. Compared with patients with normal or mildly reduced GFR, patients with moderate or severe reductions in GFR were more likely to have had a prior myocardial infarction or stroke (19.2% and 23.4% vs 28.7% and 26.9%, respectively), have ischemic changes on electrocardiography (ECG) (16.0% and 18.9% vs 24.6% and 34.1%, respectively), and have left ventricular hypertrophy on ECG (ECG-LVH) (3.9% and 4.2% vs 6.0% and 11.2%, respectively). A decrease in GFR of 10 mL/min per 1.73 m² was independently associated with a 6% higher risk for CVD and 14% higher risk for ECG-LVH. The increase in risk was marked at a GFR of approximately 60 to 70 mL/min per 1.73 m².

Conclusions  The prevalence of reduced GFR is high in older hypertensive patients. Patients with moderate or severe reduction in GFR are more likely to have a history of CVD and ECG-LVH. Even modest reductions in GFR are independently associated with a higher prevalence of CVD and ECG-LVH.

From the Divisions of Hypertension and Nephrology, Case Western Reserve University, Cleveland, Ohio (Dr Rahman); the Divisions of Nephrology, State University of New York Downstate Medical Center, Brooklyn (Dr Brown), Lehigh Valley Hospital, Allentown, Pa (Dr Kopyt), and Department of Medicine, Tufts University School of Medicine, New England Medical Center, Boston, Mass (Dr Levey); the Department of Epidemiology, Biostatistics & Medicine, The Johns Hopkins Medical Institutions, Baltimore, Md (Dr Coresh); Coordinating Center for Clinical Trials, The University of Texas Health Science Center School of Public Health, Houston (Dr Davis and Ms Pressel); the Department of Pathology and Laboratory Medicine, University of Minnesota, Minneapolis (Dr Eckfeldt); the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Mr Nwachuku); the Section of Nephrology, Louisiana State University School of Medicine, New Orleans (Dr Reisin); and Androscoggin Clinical Associates, Lewiston, Me (Dr Walworth). A complete list of the ALLHAT Collaborative Research Group was previously published (JAMA. 2002;288:2994-2996). The authors have no relevant financial interest in this article.

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