Hypertension and the development of new onset chronic kidney disease over a 10 year period: a retrospective cohort study in a primary care setting in Malaysia

Background: Little is known about the rate of progression to chronic kidney disease (CKD) among hypertensive patients, particularly at the primary care level. Methods: This study aims to examine risk factors associated with new onset CKD among hypertensive patients attending a primary care clinic.This is a 10-year retrospective cohort study of 460 patients with hypertension who were on treatment. Patient information was collected from patient records. CKD was defined as a glomerular filtration rate <60 ml/min per 1.73 m² (Cockcroft-Gault equation). Multiple logistic regression statistics was used to test the association in newly diagnosed CKD. Results: The incidence of new CKD was 30.9% (n = 142) with an annual rate of 3%. In multivariate logistic regression analysis, factors associated with development of new onset of CKD among hypertensive patients were older age (odds ratio [OR] 1.123, 95% confidence interval [CI] 1.078-1.169), presence of diabetes (OR 2.621, 95% CI 1.490-4.608), lower baseline eGFR(OR 1.041, 95% CI 0.943-0.979) and baseline hyperuricaemia (OR 1.004, 95% CI 1.001-1.007). Conclusions: The progression to new onset CKD is high among urban multiethnic hypertensive patients in a primary care population. Hence every effort is needed to detect the presence of new onset CKD earlier. Hypertensive patients who are older, with underlying diabetes, hyperuricaemia and lower baseline eGFR are associated with the development of CKD in this population

Validation of an Asian cerebrovascular risk prediction model in multiethnic country population

Objective: The importance of using risk prediction instruments to control cerebrovascular risk factors has been emphasized in most of the latest evidenced-based stroke prevention guidelines. The value of inclusion of stroke in cardiovascular risk prediction instruments are increasingly recognized as part of the outcome cluster. However, the lacking of validation of these cerebrovascular risk models in a multiethnic population limits its use in primary stroke prevention, particular in a multiethnic country. This study aimed to evaluate the validity of the Chinese Adults 10-Year Risk of Fatal and Non-fatal Ischemic Cardiovascular Diseases Risk Score. Design and method: Patients aged 35–59 were randomly selected and included in this 10-year retrospective cohort study. Patient medical records such as baseline demographic characteristics, comorbidities and cerebrovascular risk parameters were documented. The 10-Year risk scores according to Chinese Adults 10-Year Risk of Fatal and Non-fatal Ischemic Cardiovascular Diseases Risk Score were computed. Results: A total of 622 patients were studied. The actual number of stroke that occurred in the 10 years was 20 (20/662 = 3.0%) whereas the predicted was 21 (3.2%). The actual event in the low-risk group (20%); the actual event and the predicted event were 0 (0%) and 2 (29.7%) respectively. The Chinese 10-Year risk score has a poor discrimination index in this studied population as the area under the curve (AUC) is 0.43, with p value of 0.310. There was good calibration with Hosmer-Lemeshow test X2 = 4.48, P = 0.48. Conclusions: The risk score appears to underestimate stroke risk in low-risk group whereas it appears overestimate in the intermediate and high risk group. The results suggest that this risk model is unlikely to provide an appropriate stroke risk estimation. Future validation study with a larger population sample size is therefore advised

Efficacy and tolerability of lercanidipine in mild to moderate hypertension among Asians of different ethnic groups.

Introduction: Calcium channel blockers are well established modalities for the treatment of hypertension. However, in spite of the availability of many efficacious agents, hypertension control continues to be poor. One reason is poor tolerability due to adverse events. Racial differences also exist. Lercanidipine, a third-generation calcium channel blocker, is associated with better tolerability. However, it has not been studied in the Asian population. This study examines its efficacy and tolerability in Asian subjects of different ethnicities. Methods: This was an eight-week open label study of adults with mild to moderate hypertension. Blood pressure (BP), pulse rate, self-administered symptom check and laboratory evaluations were done at baseline. Patients were prescribed 10 mg lercanidipine, with up-titration to 20 mg if BP was not controlled at Week 4. Baseline evaluations were repeated at Week 8. Adverse events were also enumerated. Results: 27 patients (mean age 53.4 +/- 12.1 years) completed the study. The baseline systolic BP (SBP), diastolic BP (DBP) and heart rate was 159 +/- 12.2, 96.6 +/- 7.7 mmHg and 71 +/- 13/min, respectively. Three racial groups were represented. SBP and DBP decreased significantly after four weeks of therapy. A further reduction to 139 +/- 14.3 and 88 +/- 9.8 (p-value is less than 0.0001) was seen in Week 8. The absolute SBP and DBP reduction was 20.5 mmHg (95 percent confidence interval [CI] 16.5-24.5, p-value is less than 0.0001) and 9.3 mmHg (95 percent CI 6.2-12.5, p-value is less than 0.0001), respectively. All adverse symptoms, except for palpitations, were reduced at the end of the study. Conclusion: Lercanidipine is efficacious and well tolerated in Asians of different ethnicities. Its BP lowering effects and tolerability in Asians appear to be similar to other studies on Caucasians and other calcium channel blockers

Review of tools of cardiovascular disease risk stratification: interpretation, customisation and application in clinical practice

Cardiovascular Disease (CVD) is the leading cause of death in both developed and developing countries. While it is relatively easy to identify those who are obviously at high risk and those at the lowest risk for CVD, it is often the large group of individuals with what appears to be modestly abnormal risk factors who contributes most to the burden of CVD. This is where estimation of CVD risk is necessary. Many tools for risk assessment have been devised. All these risk scores have their own inherent advantages and disadvantages. Furthermore, they may also not be directly applicable to a local population. Ideally, each country should have its own risk score that takes into account other factors as well. In the interim, it is worthwhile to be familiar with one of these scores, select one that is most appropriate for your patient and discuss treatment options based on the estimated risk

Prevalence and determinants of left ventricular hypertrophy in hypertensive patients at a primary care clinic

Left ventricular hypertrophy (LVH) has prognostic significance on cardiovascular mortality and morbidity. However, echocardiography screening for LVH is not routinely done for hypertensive patients in a primary care setting. Thus, this quantitative study aims to determine the prevalence and factors associated with LVH in hypertensive patients at a primary care setting. This was a cross sectional study of 359 consecutive patients with uncomplicated essential hypertension attending a hospital-based clinic in Malaysia. All subjects underwent an echocardiography test. LVH occur when the left ventricular posterior wall thickness together with inter-ventricular septal thickness is ≥11 mm. It was found that 24% patients fulfilled the criteria for LVH. The mean age of the study population was 59.2±7.7 years; mean duration of hypertension was 9.7±7.5 years; and mean blood pressure was 136.5/81.5 (±13.7/7.7) mmHg. Using multiple logistic regression analysis, patients who were obese [odds ratio (OR) 8.34, 95% confidence interval (CI) 3.14, 22.22] and male gender (OR 1.96, 95% CI 1.08, 3.16) had significant positive association with LVH. LVH was found in approximately one fourth of the hypertensive patients at a hospital-based primary care setting. There was a significant positive association between LVH and obesity and being male. Guidelines for enhancing use of echocardiography in detecting LVH may be needed