Abstract
We aimed to evaluate the association of albuminuria and estimated glomerular filtration rate (eGFR) at baseline and changes in these parameters with left ventricular mass index (LVMI) at 7 years in adults with hypertension from communities in Pakistan. A nested cohort of 539 hypertensives aged 40 years and older from a community-living population in Karachi, Pakistan, followed up for 7 years in the Control of Blood Pressure and Risk Attenuation trial. Urine spot albumin-to-creatinine ratio (UACR) and serum creatinine-based eGFR were assessed at baseline and 7 years, and echocardiography at 7 years. Mean age of participants was 50.9 ± 9.1 (standard deviation) years; 63% were female. Mean eGFR was 91.0 ± 15.9 (standard deviation) mL/min/1.73 m2 and median (interquartile range) UACR 6.2 (3.9, 11.3) mg/g. In multivariate analysis, although baseline eGFR was marginally associated with LVMI, a strong association was found between higher LVMI with greater rate of decline in eGFR (β = −1.05; 95% confidence interval [CI]: [−1.94, −0.17]). Higher baseline UACR was significantly associated with higher follow-up LVMI (β = 2.26; 95% CI: [0.87, 3.65]), as was rate of UACR increase of ≥1.07 mg/g/y versus of <0.14 mg/g/y. (β = 4.19; 95% CI: [0.75, 7.63]). Associations with developing left ventricular hypertrophy were found for reduced baseline eGFR, higher baseline UACR, and greater rate of UACR increase, but not for rate of eGFR decline. Comparable results were observed for the outcomes of posterior wall thickness and septal wall thickness. Higher baseline albuminuria, lower baseline eGFR, and their longitudinal worsening were significantly associated with higher LVMI or the development of left ventricular hypertrophy among individuals with hypertension in Pakistan.
Highlights
Supplemental Material can be found at www.ashjournal.com
Our study examining the association of markers of kidney function and damage with left ventricular mass index (LVMI) among 539 hypertensive individuals with near normal kidney function from the general population in communities in Pakistan found that higher baseline Urine spot albumin-tocreatinine ratio (UACR), greater rate of increase in UACR, and greater rate of decline in estimated glomerular filtration rate (eGFR) were strongly and independently associated with higher LVMI at the 7-year follow-up
Similar results were found for posterior wall thickness (PWT) and septal wall thickness (SWT), except that rate of eGFR decline was not associated SWT
Summary
Supplemental Material can be found at www.ashjournal.com. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript. MD, MPH, Program in Health Services & Systems Research, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore.
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