American Heart Association, Hypertension, 1(61), p. 18-26, 2013
DOI: 10.1161/hypertensionaha.112.197376
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No previous study addressed whether in the general population estimated glomerular filtration rate (eGFR [Chronic Kidney Disease Epidemiology Collaboration formula]) adds to the prediction of cardiovascular outcome over and beyond ambulatory blood pressure. We recorded health outcomes in 5322 subjects (median age, 51.8 years; 43.1% women) randomly recruited from 11 populations, who had baseline measurements of 24-hour ambulatory blood pressure (ABP 24 ) and eGFR. We computed hazard ratios using multivariable-adjusted Cox regression. Median follow-up was 9.3 years. In fully adjusted models, which included both ABP 24 and eGFR, ABP 24 predicted ( P ≤0.008) both total (513 deaths) and cardiovascular (206) mortality; eGFR only predicted cardiovascular mortality ( P =0.012). Furthermore, ABP 24 predicted ( P ≤0.0056) fatal combined with nonfatal events as a result of all cardiovascular causes (555 events), cardiac disease (335 events), or stroke (218 events), whereas eGFR only predicted the composite cardiovascular end point and stroke ( P ≤0.035). The interaction terms between ABP 24 and eGFR were all nonsignificant ( P ≥0.082). For cardiovascular mortality, the composite cardiovascular end point, and stroke, ABP 24 added 0.35%, 1.17%, and 1.00% to the risk already explained by cohort, sex, age, body mass index, smoking and drinking, previous cardiovascular disease, diabetes mellitus, and antihypertensive drug treatment. Adding eGFR explained an additional 0.13%, 0.09%, and 0.14%, respectively. Sensitivity analyses stratified for ethnicity, sex, and the presence of hypertension or chronic kidney disease (eGFR <60 mL/min per 1.73 m 2 ) were confirmatory. In conclusion, in the general population, eGFR predicts fewer end points than ABP 24 . Relative to ABP 24 , eGFR is as an additive, not a multiplicative, risk factor and refines risk stratification 2- to 14-fold less.