to Cardiovascular Outcomes (IDACO) Investigators in relation Filtration Rate in 5322 Subjects From 11 Populations Risk Stratification by 24-Hour Ambulatory Blood Pressure and Estimated Glomerular

a proportion of the world’s adult population. Both entities substantially increase the risk of death, cardiovascular disorders, and progression to renal failure, even after accounting for other risk factors. 1 Hypertension and renal disease behave as aggregate risk factors, high blood pressure Abstract —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. ( Hypertension . 2013;61:18-26. ) ● Online Data Supplement (see Expanded Methods in the online-only Data Supplement) 34 to assess the refinement in risk prediction by adding the 24-hour blood pressure or eGFR to Cox models on top of other covariables. Statistical significance was an α -level of <0.05 on 2-sided tests. the Chronic Disease Epidemiology Collaboration equation (CKD-EPI), in reference 17. Hazard ratios, presented with 95% confidence interval (CI), express the risk associated with a 1-SD increase in 24-h systolic blood pressure (14.2 mm Hg) or a 1-SD decrease in eGFR (16.7 ml/min/1.73 m 2 ). For eGFR, the inverse of the hazard ratio is presented, so that higher values, associated with lower eGFR, reflect higher risk. All models were adjusted for center, sex, age, body mass index, smoking and drinking, serum cholesterol, diabetes mellitus, history of cardiovascular disease, and antihypertensive treatment and include both the 24-h systolic blood pressure or eGFR. EPOGH (European Project on Genes in Hypertension) includes participants recruited Novosibirsk, Padova and eGFR is the glomerular filtration rate estimated from the Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI), as given in reference 17. Hazard ratios, presented with 95% confidence interval (CI), express the risk associated with a 1-SD increase in 24-h systolic blood pressure (14.2 mm Hg) or a 1-SD decrease in eGFR (16.7 ml/min/1.73 m 2 ). For eGFR, the inverse of the hazard ratio is presented, so that higher values, associated with lower eGFR, reflect higher risk. All models were adjusted for center, sex, age, body mass index, smoking and drinking, serum cholesterol, diabetes mellitus, history of cardiovascular disease, and antihypertensive treatment and include both the 24-h systolic blood pressure or eGFR. EPOGH (European Project on Genes in Hypertension) includes participants recruited at Kraków, Novosibirsk, Padova and Pilsen.