Impact of renal function on cardiovascular events in elderly hypertensive patients treated with efonidipine

Koichi Hayashi, Takao Saruta, Yoshio Goto, Masao Ishii

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34 Citations (Scopus)

Abstract

This study evaluated the impact of renal function on cardiovascular outcomes in elderly hypertensive patients enrolled in the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive patients. The patients were randomly assigned to either a strict-treatment group (target systolic blood pressure (BP) <140 mm Hg, n2212) or a mild-treatment group (target systolic BP, 140 to 160 mm Hg, n2206), each with efonidipine (a T/L-type Ca channel blocker)-based regimens. Cardiovascular events (stroke, cardiovascular disease and renal disease) were evaluated during the 2-year follow-up period following the prospective randomized open-blinded end-point method. Estimated glomerular filtration rate (eGFR) was elevated throughout the trial period in both the strict-treatment (59.4-62 ml min 1 per 1.73 m 2) and the mild-treatment group (58.8-61.4 ml min-1 per 1.73 m2). This tendency was also observed in diabetic patients and patients aged 75 years, with baseline eGFR60 ml min 1 per 1.73 m 2. Baseline eGFR (60 vs. 60 ml min-1 per 1.73 m2) had no definite relationship with the incidence of cardiovascular events, nor did the level of BP control. Proteinuria at the time of entry into the study, however, was significantly correlated with cardiovascular event rates (7.1%), an association that was more apparent in patients with eGFR60 ml min-1 per 1.73 m2 (8.2%). Furthermore, the event rate was more elevated in patients with greater declines in eGFR and was amplified when the baseline eGFR was 60 ml min-1 per 1.73 m2. In conclusion, the rates of decline of renal function and proteinuria constitute critical risk factors for cardiovascular events in elderly hypertensive patients, trends that are enhanced when baseline eGFR is diminished. Furthermore, the fact that efonidipine-based regimens ameliorate renal function in elderly hypertensive patients with chronic kidney disease may offer novel information on the mechanisms of cardiovascular protection.

Original languageEnglish
Pages (from-to)1211-1220
Number of pages10
JournalHypertension Research
Volume33
Issue number11
DOIs
Publication statusPublished - 2010 Nov 1

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Keywords

  • Ca channel blockers
  • cardiovascular events
  • chronic kidney disease
  • elderly hypertension

ASJC Scopus subject areas

  • Internal Medicine
  • Physiology
  • Cardiology and Cardiovascular Medicine

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