Systolic blood pressure values might further risk-stratify the adverse outcomes of LVH in older patients with chronic kidney disease.

Brent Deschaine,Amanda M. Thompson,Carlos R. Franco Palacios,Pankaj Goyal

doi:10.1186/s40885-016-0056-7

Abstract

BackgroundLVH is highly prevalent in patients with CKD and is independently associated with subsequent cardiovascular events.We hypothesized that adding systolic blood pressure values to LVH might differentiate different subgroups of patients at higher risk of cardiovascular events (CVE) and other adverse outcomes.MethodsRetrospective cohort study of 243 patients older than 60 years with stages 1-5 pre-dialysis CKD. LVH was assessed by electrocardiogram or echocardiogram.ResultsCardiovascular events occurred in 7 patients (10.3%) among those with SBP <130 and no LVH, 8 patients (10.5%) among those with SBP ≥130 and no LVH, 7 patients (21.2%) among those with SBP <130 and LVH and 25 patients (37.9%) among those with SBP ≥ 130 and LVH.On multivariate analyses, comparing to SBP < 130 and no LVH, the HR for CVE in those with SBP ≥ 130 and LVH was 4 (1.75, 10.3), p = 0.0007; 2.13 (0.71, 6.32) p = 0.16 in those with SBP <130 and LVH and 1.20 (0.42, 3.51) p = 0.72 in those with SBP ≥130 and no LVH.No significant differences were noted in changes in renal function and mortality rates among the groups.ConclusionThe combination of higher systolic blood pressure and LVH might identify older patients with CKD at higher risk of cardiovascular outcomes.

Highlights

Left ventricular hypertrophy (LVH) is highly prevalent in patients with chronic kidney disease (CKD) and is independently associated with subsequent cardiovascular events
The objective of this study was to assess the prognostic value of combining LVH data with clinical data (SBP) as markers of adverse outcomes in older patients with CKD
Since prior studies in older patients with CKD suggest that mortality is lower for a systolic blood pressures (SBP) around 130 mmHg, we decided to use this value as reference [8]

Summary

Introduction

LVH is highly prevalent in patients with CKD and is independently associated with subsequent cardiovascular events. Left ventricular hypertrophy (LVH) is a known manifestation of hypertensive target organ damage. LVH is highly prevalent in patients with CKD and is already present in the early stages of the disease. Its prevalence increases with age, anemia, hypertension and lower renal function [1, 2]. More advanced CKD at baseline may be associated with larger longitudinal increases in left ventricular mass and volume and greater deterioration in diastolic function [3]. More severe LVH is associated with kidney function decline and progression to dialysis [4, 5]

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