Low Glomerular Filtration Rate, Recurrent Stroke Risk, and Effect of Renin–Angiotensin System Modulation
- 1 November 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 44 (11), 3223-3225
- https://doi.org/10.1161/strokeaha.113.002463
Abstract
Background and Purpose—: To investigate the association of low estimated glomerular filtration rate (eGFR) <60 mL/min with recurrent stroke risk and to evaluate whether add-on renin–angiotensin system modulator therapy is associated with lower recurrent stroke risk in patients with low eGFR. Methods—: We analyzed the database of a multicenter trial involving 18 666 patients with recent ischemic stroke followed for 2.5 years. Primary outcome was time to first recurrent stroke. Independent associations of low eGFR with outcome in the entire cohort and add-on telmisartan treatment with outcome among those with low eGFR were evaluated. Results—: Low eGFR was observed in 3630 (20.1%) patients. Patients with low eGFR were older, more likely women, with a known history of hypertension. In unadjusted analyses, patients with low eGFR were more likely to experience a recurrent stroke (hazard ratio, 1.34; 95% confidence interval, 1.20–1.49). After adjusting for confounders, low eGFR was still associated with recurrent stroke but to a lesser extent (hazard ratio, 1.16; 95% confidence interval, 1.04–1.31). Telmisartan treatment among patients with low eGFR was not independently associated with recurrent stroke (hazard ratio, 1.08; 95% confidence interval, 0.89–1.31). Conclusions—: Low eGFR is independently associated with a higher risk of recurrent stroke, but short-term add-on telmisartan therapy does not seem to mitigate this risk. Clinical Trial Registration—: URL: http://www.clinicaltrials.gov . Unique identifier: NCT00153062.This publication has 8 references indexed in Scilit:
- Low glomerular filtration rate and risk of stroke: meta-analysisBMJ, 2010
- Telmisartan to Prevent Recurrent Stroke and Cardiovascular EventsThe New England Journal of Medicine, 2008
- Meta-analysis: Effect of Monotherapy and Combination Therapy with Inhibitors of the Renin–Angiotensin System on Proteinuria in Renal DiseaseAnnals of Internal Medicine, 2008
- Chronic Kidney Disease, Cardiovascular Events, and the Effects of Perindopril-Based Blood Pressure LoweringJournal of the American Society of Nephrology, 2007
- Chronic Kidney Disease, Cardiovascular Risk, and Response to Angiotensin-Converting Enzyme Inhibition After Myocardial InfarctionCirculation, 2004
- National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and StratificationAnnals of Internal Medicine, 2003
- The elephant in uremia: Oxidant stress as a unifying concept of cardiovascular disease in uremiaKidney International, 2002
- A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction EquationAnnals of Internal Medicine, 1999