The Prevalence of Reduced Glomerular Filtration Rate in Older Hypertensive Patients and Its Association With Cardiovascular DiseaseA Report From the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial

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Abstract
Approximately 8 million adults (4.5% of the US population) are estimated to have moderate or severe reductions in glomerular filtration rate (GFR; ≤59 mL/min per 1.73 m2).1 However, few large-scale epidemiological studies have been performed to determine the prevalence of decreased GFR in older patients, racial/ethnic minorities, and patients who are at high risk for cardiovascular disease (CVD). Accurate estimation of the prevalence of decreased GFR in previous studies has been limited by the variability of serum creatinine measurements between laboratories and the lack of sensitivity of serum creatinine level used as a sole measure of renal function.2 The National Kidney Foundation Kidney Disease Outcome Quality Initiative (K/DOQI) Clinical Practice Guidelines on Chronic Kidney Disease (CKD) now recommend the use of equations, such as those derived from the Modification of Diet in Renal Disease (MDRD) study, that incorporate age, race, and sex in addition to serum creatinine level for estimation of GFR.3,4 Early identification of patients with decreased GFR has important clinical and research implications. In addition, it is well recognized that the prevalence of CVD is very high in patients with end-stage renal disease (ESRD).5 However, the epidemiology of CVD in patients with earlier stages of chronic renal disease and the relationship of GFR to CVD are not well documented. It is also not clear whether the increased risk for CVD seen in patients with renal disease is due to the coexistence of multiple traditional cardiovascular risk factors (eg, hypertension, diabetes, or smoking) or independently related to the decrement in GFR.

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