Document Detail


Impact of renal function on cardiovascular events in elderly hypertensive patients treated with efonidipine.
MedLine Citation:
PMID:  20844543     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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, n=2212) or a mild-treatment group (target systolic BP, 140 to <160 mm Hg, n=2206), 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 m²) 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 eGFR<60 ml min⁻¹ per 1.73 m². 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 eGFR<60 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.
Authors:
Koichi Hayashi; Takao Saruta; Yoshio Goto; Masao Ishii;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial     Date:  2010-09-16
Journal Detail:
Title:  Hypertension research : official journal of the Japanese Society of Hypertension     Volume:  33     ISSN:  1348-4214     ISO Abbreviation:  Hypertens. Res.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-05     Completed Date:  2011-02-28     Revised Date:  2011-04-20    
Medline Journal Info:
Nlm Unique ID:  9307690     Medline TA:  Hypertens Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  1211-20     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan. khayashi@sc.itc.keio.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Antihypertensive Agents / therapeutic use*
Cardiovascular Diseases / etiology*
Chronic Disease
Dihydropyridines / therapeutic use*
Female
Humans
Hypertension / complications*,  drug therapy*
Kidney / drug effects,  physiopathology*
Kidney Diseases / physiopathology,  prevention & control*
Male
Nitrophenols / therapeutic use*
Organophosphorus Compounds / therapeutic use
Prospective Studies
Chemical
Reg. No./Substance:
0/Antihypertensive Agents; 0/Dihydropyridines; 0/Nitrophenols; 0/Organophosphorus Compounds; 111011-53-1/efonidipine
Comments/Corrections
Comment In:
Hypertens Res. 2010 Nov;33(11):1112-3   [PMID:  20811385 ]
Hypertens Res. 2010 Nov;33(11):1110-1   [PMID:  20861840 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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