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Abstract: TH-OR41

Role of Hypertension in the Risk of Heart Failure in CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Hartsell, Sydney Elizabeth, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Agarwal, Adhish, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Fang, James Chen-Tson, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Bress, Adam, The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Cheung, Alfred K., The University of Utah School of Medicine, Salt Lake City, Utah, United States
  • Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States
Background

Chronic kidney disease (CKD) is a risk factor for heart failure (HF), but the extent to which hypertension (HTN) contributes to development of HF in CKD is unclear.

Methods

We used the VA Informatics and Computing Infrastructure (VINCI) platform to identify a national cohort of veterans with prevelant CKD (two or more outpatient CKD-EPI eGFR <60 ml/min/1.73m2 taken 60 days apart from January 2010 to December 2015). We used inpatient and outpatient ICD 9/10 codes to define HF admissions and incident HF through August 2018. We first related CKD stages at baseline with the time to HF hospitalizations and incident HF with adjustment for demographics and baseline comorbidity in a multivariable Cox regression. Next, we adjusted for baseline blood pressure (BP) and BP-lowering medications (BP meds). Finally, we conducted a time varying Cox regression model with 3-month averages of BP values and BP meds.

Results

Of the 915,038 veterans with prevelant CKD, we included 632,872 (69%) without known HF at baseline. Over about 3.5 million patient-years of follow up, 111,549 (18%) patients developed HF and 29,597 (5%) were hospitailized for HF. Compared to stage 3A CKD, more advanced CKD stages were significantly associated with HF incidence and admissions (Fig 1). Results were similar when adjusted for demographics only (incident HR 1.63 (95%CI 1.52-1.74); admission HR 2.28 (95%CI 2.05-2.53)) or with addition of comorbidities and atherosclerotic risk factors (Fig 1). Controlling for time-varying BP and BP meds significantly attenuated these hazard ratios (Fig 1). Results were similarly attenuated using baseline BP and BP meds (incident HR 1.06(95%CI 0.99-1.13); admission HR 1.24 (95%CI 1.12-1.38).

Conclusion

Adjusting for HTN to a large degree attenuates the increased risk of HF observed in patients with CKD. Interventional trials targeting BP are needed to establish whether intensive BP control can reduce the risk of HF in CKD.

Hazard of HF incidence and admissions in CKD

Funding

  • NIDDK Support