scholarly journals Association of Acute Kidney Injury with Cardiovascular Events and Death in Systolic Blood Pressure Intervention Trial

2019 ◽  
Vol 49 (5) ◽  
pp. 359-367
Author(s):  
Brad P. Dieter ◽  
Kenn B. Daratha ◽  
Sterling M. McPherson ◽  
Robert Short ◽  
Radica Z. Alicic ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Intervention Trial ◽  
Major Cardiovascular Events

Rationale and Objective: In the Systolic Blood Pressure Intervention Trial, the possible relationships between acute kidney injury (AKI) and risk of major cardiovascular events and death are not known. Study Design: Post hoc analysis of a multicenter, randomized, controlled, open-label clinical trial. Setting and Participants: Hypertensive adults without diabetes who were ≥50 years of age with prior cardiovascular disease, chronic kidney disease (CKD), 10-year Framingham risk score > 15%, or age > 75 years were assigned to a systolic blood pressure target of < 120 mm Hg (intensive) or < 140 mm Hg (standard). Predictor: AKI episodes. Outcomes: The primary outcome was a composite of myocardial infarction, acute coronary syndrome, stroke, decompensated heart failure, or cardiovascular death. The secondary outcome was death from any cause. Analytical Approach: AKI was defined using the Kidney Disease: Improving Global Outcomes modified criteria based solely upon serum creatinine. AKI episodes were identified by serious adverse events or emergency room visits. Cox proportional hazards models assessed the risk for the primary and secondary outcomes by AKI status. Results: Participants were 68 ± 9 years of age, 36% women (3,332/9,361), and 30% Black race (2,802/9,361), and 17% (1,562/9,361) with cardiovascular disease. Systolic blood pressure was 140 ± 16 mm Hg at study entry. AKI occurred in 4.4% (204/4,678) and 2.6% (120/4,683) in the intensive and standard treatment groups respectively (p < 0.001). Those who experienced AKI had higher risk of cardiovascular events (hazard ratio [HR] 1.52, 95% CI 1.05–2.20, p = 0.026) and death from any cause (HR 2.33, 95% CI 1.56–3.48, p < 0.001) controlling for age, sex, race, baseline systolic blood pressure, body mass index, number of antihypertensive medications, cardiovascular disease and CKD status, hypotensive episodes, and treatment assignment. Limitations: The study was not prospectively designed to determine relationships between AKI, cardiovascular events, and death. Conclusions: Among older adults with hypertension at high cardiovascular risk, intensive treatment of blood pressure independently increased risk of AKI, which substantially raised risks of major cardiovascular events and death.

Abstract 16532: Impact of Systolic Blood Pressure on Cardiovascular Disease in a Chinese Population: A Mendelian Randomization Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Robert Clarke ◽  
Liming Li ◽  
Derrick Bennett ◽  
Iona Y Millwood ◽  
Robin G Walters ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Systolic Blood Pressure ◽  
Cardiovascular Events ◽  
Mendelian Randomization ◽  
Haemorrhagic Stroke ◽  
Candidate Snps ◽  
Genetic Score ◽  
Relative Risks ◽  
Major Cardiovascular Events

Aims: To investigate the quantitative importance of systolic blood pressure (SBP) for cardiovascular disease using a Mendelian randomization analysis and compare the risk associations with equivalent differences in standard measures of SBP after correction for regression dilution. Methods: In the China Kadoorie Biobank prospective study, 82,373 unrelated adults aged 30-79 years had SBP recorded and were genotyped for 384 candidate SNPs, including 32 SNPs previously associated with blood pressure. These SNPs were combined to generate a genetic score for SBP (GS-SBP) and estimate the associated relative risks (RR) and 95% confidence intervals (CI) of major cardiovascular events (stroke, and non-fatal MI or IHD death). The results were compared with the RRs for 20 mmHg higher SBP before and after correction for regression dilution (basal or usual SBP).The correlation coefficient between replicate measurements of SBP between baseline and a re-survey after 3 years was 0.6 and was used to correct for regression dilution. Results: The overall mean (SD) age at survey was 51 (10.7) years and mean (SD) SBP was 131.9 (22.2) mmHg, but only 4.8% reported use of any anti-hypertensive treatment. Overall, there was a 5 mmHg difference in the mean SBP between the top and bottom fifths of the GS-SBP. After adjustment for regression dilution, each 20 mmHg higher usual SBP was associated with RRs of 1.78, 2.45, 1.61, and 1.84 for ischaemic stroke, haemorrhagic stroke, non-fatal MI or IHD death and major cardiovascular events, respectively (Table). For GS-SBP, the corresponding RRs were much more extreme, being 2.48, 2.85, 1.85 and 2.69, respectively. Conclusions: This Mendelian randomization study demonstrates that the effects of long-term differences in SBP for risk of major cardiovascular events in this largely untreated population were almost 50% greater than those estimated for standard measures of SBP after correction for regression dilution.

Angiopoietins as Prognostic Markers for Future Kidney Disease and Heart Failure Events After Acute Kidney Injury

2022 ◽  
pp. ASN.2021060757
Author(s):  
Sherry Mansour ◽  
Pavan Bhatraju ◽  
Steven Coca ◽  
Wassim Obeid ◽  
Francis Wilson ◽  
...  
Keyword(s):  
Heart Failure ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Lower Risk ◽  
Kidney Injury ◽  
Early Response ◽  
Secondary Outcome ◽  
Ckd Progression ◽  
Angiopoietin 2 ◽  
Vessel Stability

Background The mechanisms underlying long-term sequelae following acute kidney injury (AKI) remain unclear. Vessel instability, an early response to endothelial injury, may reflect a shared mechanism and early trigger for chronic kidney disease (CKD) and heart failure. Methods To investigate whether plasma angiopoietins, markers of vessel homeostasis, are associated with CKD progression and heart failure admissions after hospitalization in patients with and without AKI, we conducted a prospective cohort study to analyze the balance between angiopoietin-1 (Angpt-1), which maintains vessel stability, and angiopoietin-2 (Angpt-2), which increases vessel destabilization. Three months after discharge, we evaluated the associations between angiopoietins and development of the primary outcomes of CKD progression and heart failure, as well as the secondary outcome of all-cause mortality 3 months after discharge or later. Results Median age for the 1503 participants was 65.8 years; 746 (50%) had AKI. Compared with the lowest quartile, the highest quartile of the Angpt-1:Angpt-2 ratio was associated with 72% lower risk of CKD progression (adjusted hazard ratio [aHR], 0.28; 95% confidence interval [95% CI], 0.15 to 0.51), 94% lower risk of heart failure (aHR, 0.06; 95% CI, 0.02 to 0.15), and 82% lower risk of mortality (aHR, 0.18; 95% CI, 0.09 to 0.35) for those with AKI. Among those without AKI, the highest quartile of Angpt-1:Angpt-2 ratio was associated with 71% lower risk of heart failure (aHR, 0.29; 95% CI, 0.12 to 0.69) and 68% less mortality (aHR, 0.32; 95% CI, 0.15 to 0.68). There were no associations with CKD progression. Conclusions A higher Angpt-1:Angpt-2 ratio was strongly associated with less CKD progression, heart failure, and mortality in the setting of AKI.

Specific diseases: renal disease

ESC CardioMed ◽  
2018 ◽  
pp. 2670-2673
Author(s):  
Susanna Price
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Risk Factor ◽  
Kidney Disease ◽  
Renal Disease ◽  
Independent Risk Factor ◽  
Hospital Admissions ◽  
Kidney Injury ◽  
Potential Methods

Chronic kidney disease is a global health burden, with an estimated prevalence of 11–13%, with the majority of patients diagnosed as stage 3, and is an independent risk factor for cardiovascular disease. The incidence of acute kidney injury is increasing, and estimated to be present in one in five acute hospital admissions, and there is a bidirectional relationship between acute and chronic kidney disease. The relevance to the patient with cardiovascular disease relates to increased perioperative risk, as reduced kidney function is an independent risk factor for adverse postoperative cardiovascular outcomes including myocardial infarction, stroke, and progression of heart failure. Furthermore, patients undergoing cardiovascular investigations are at risk of developing acute kidney injury, in particular where iodinated contrast is administered. This chapter reviews the classification of renal disease and its impact on cardiovascular disease, as well as potential methods for reducing the development of contrast-induced acute kidney injury.

scholarly journals Cognitive Function and Kidney Disease: Baseline Data From the Systolic Blood Pressure Intervention Trial (SPRINT)

2017 ◽  
Vol 70 (3) ◽  
pp. 357-367 ◽  
Author(s):  
Daniel E. Weiner ◽  
Sarah A. Gaussoin ◽  
John Nord ◽  
Alexander P. Auchus ◽  
Gordon J. Chelune ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cognitive Function ◽  
Kidney Disease ◽  
Systolic Blood Pressure ◽  
Baseline Data ◽  
Intervention Trial

Dialysis Requirement and Long-Term Major Adverse Cardiovascular Events in Patients with Chronic Kidney Disease and Superimposed Acute Kidney Injury

Nephron ◽  
2017 ◽  
Vol 136 (2) ◽  
pp. 95-102 ◽  
Author(s):  
Bolanle A. Omotoso ◽  
Faruk Turgut ◽  
Emaad M. Abdel-Rahman ◽  
Wenjun Xin ◽  
Jennie Z. Ma ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Kidney Injury ◽  
Major Adverse Cardiovascular Events
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