These differences are mainly based on the increased prevalence of diabetes in hypertensive patients with kidney disease. However, the risk of coronary death and non-coronary cardiovascular death, calculated in accordance with the SCORE project, showed no differences between the groups with and without renal disease. This apparent paradox can be explained by the inability of the SCORE method to detect differences in population risk when these differences are derived from a varying prevalence of diabetes.
This point has been the subject of an earlier communication.
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The prevalence of renal disease in the group of hypertensive patients studied was 9. In fact, the prevalence of renal disease in groups of persons from the general population without hypertension or diabetes is already estimated to be 6.
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Consequently, the patients with just microalbuminuria were not considered to have renal disease for the purposes of this study. In the general population it is estimated that for each patient with gross proteinuria there are 11 with microalbuminuria, 23 and that half the patients with diabetes have some degree of proteinuria, half gross and the other half microalbuminuria. Our results are applicable to hypertensive patients with proteinuria according to the terms of this study. Could our results be extended to other populations with hypertension in whom renal disease is considered based solely on the presence of microalbuminuria or an increase in the glomerular filtration rate?
Qualitatively, we believe so; that the increases in cardiovascular risk, the greater involvement of other organs and the increased association with other cardiovascular diseases, which were shown in this study, are in fact common to all groups of hypertensive patients with kidney disease. Quantitatively, however, we think not, as the percentages of patients with an increased risk and cardiovascular involvement were significantly greater in relation to the amount of proteinuria. Relevant data exist concerning this aspect; microalbuminuria is known to be a previous step to proteinuria. The patients with gross proteinuria, detectable at the bedside, had a greater cardiovascular risk than those who only had microalbuminuria.
On the other hand, the high prevalence of diabetes in patients with kidney disease may be an expression that the diabetes itself is, together with the hypertension, the origin of the kidney disease..
Hypertensive patients with gross proteinuria or increased blood creatinine, or both, had symptoms of the metabolic syndrome, a very increased prevalence of diabetes, and a significantly increased risk for a coronary event. Hospital La Fe. Campanar, Manuscript received December 13, Accepted for publication June 14, Home Articles in press Current Issue Archive. ISSN: Previous article Next article. Issue Pages October Download PDF. This item has received.
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Introduction and objectives. The presence of renal disease significantly alters the cardiovascular risk of patients with high blood pressure.
However, few studies have examined renal parameters in primary care patients. The objectives of this study were to investigate cardiovascular risk and the factors influencing it in hypertensive patients with renal disease and to compare the findings with those in hypertensive patients without renal disease. In total, patients 9. Hypertensive patients with renal disease had a worse cardiovascular risk profile than other hypertensives. The prevalence of diabetes was double in patients with renal disease.
Moreover, the risk of a coronary event was significantly higher in those with renal disease. One-third of hypertensives with renal disease had another previously diagnosed cardiovascular disease. In addition, they more frequently had a history of angina, were twice as likely to have had a myocardial infarction, and were more than twice as likely to have undergone revascularization or to have peripheral vascular disease or cerebrovascular disease. Heart failure was four times more frequent in these patients with renal disease than in other hypertensives.
Patients with hypertension and renal disease have a higher risk of cardiovascular disease, exhibit an increased prevalence of diabetes, and suffer from more extensive target organ damage.. Systemic hypertension. La prevalencia de la diabetes fue el doble en los grupos de pacientes renales. Palabras clave:. The prognosis in both stages worsens, especially in Stage 3, in which secondary prevention is involved.
This report provides the analysis of these data, undertaken in order to determine the differences between these hypertensive patients with renal disease and other hypertensive patients. The primary aim of the study, which has been the subject of other reports, was to obtain significant reductions in coronary risk, as calculated with the Framingham equation, induced by treatment with amlodipine for 12 months.
The selection period was limited to 2 months. Procedures All the patients underwent a medical examination which included measurements of weight, height, BP and heart rate, as well as recording any history of diabetes, dyslipidemia, hypertension, smoking, myocardial infarction, angina, myocardial revascularization procedures, congestive heart failure, cerebrovascular disease, peripheral vascular disease, retinopathy, and chronic nephropathy.
All the procedures and questionnaires were performed by the corresponding primary care physician. Statistical Analysis The estimation of the year risk for coronary disease for each patient was obtained from the Framingham equation detailed in the appendix to the article by Wilson et al, 15 calibrated for Spain according to the appendix of the article by Marrugat et al.
Models for a low-risk region were followed as well as a model that uses the association between cholesterol and HDL cholesterol HDL-C as a risk factor instead of just total cholesterol. Kidney disease was more common in older patients with hypertension and in those with a previous diagnosis of hypertension; it was not associated with a family history of cardiovascular disease. J Hypertens, 17 , pp. The clinical epidemiology of cardiac disease in chronic renal failure.. The UNWTO Elibrary is an information source offering an unparalleled coverage of research and information in the area of tourism and available to our Member States, Affiliate Members, subscribers and general public.
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