EARLY PREDICTORS OF 15-YEAR END-STAGE RENAL-DISEASE IN HYPERTENSIVE PATIENTS

There has been a continuing increase in the incidence of end-stage ren al disease (ESRD) in the United States, including the fraction that ha s been attributed to hypertension. This study was done to seek relatio nships between ESRD and pretreatment clinical data and between ESRD an d early treated blood pressure data in a population of hypertensive ve terans. We identified a total of 5730 black and 6182 nonblack male vet erans as hypertensive from 1974 through 1976 in 32 Veterans Administra tion Hypertension Screening and Treatment Program clinics. Their mean age was 52.5+/-10.2 years, and their mean pretreatment blood pressure was 154.3+/-19.0/ 100.8+/-9.8 mm Hg. During a minimum of 13.9 years of followup, 5337 (44.8%) of these patients died and 245 developed ESRD. For 1055 of these subjects, pretreatment systolic blood pressure (SBP ) was greater than 180 mm Hg; 901 were diabetic; 1471 had a history of urinary tract problems; and 2358 of the 9644 who were treated had an early fall in SBP of more than 20 mm Hg. We used proportional hazards modeling to fit multivariate survival models to determine the effect o f the available pretreatment data and early treated blood pressure lev els on ESRD. This model demonstrated the independent increased risk of ESRD associated with being black or diabetic (risk ratio, 2.2 or 1.8) , having a history of urinary tract problems (risk ratio, 2.2), or hav ing high pretreatment SBP (for SPP 165 to 180 mm Hg, risk ratio was 2. 8; for SBP >180 mm Hg, risk ratio was 7.6). In addition, myocardial in farction during follow-up increased the risk of subsequent ESRD almost twofold, and congestive heart failure increased it more than fivefold . The rate of ESRD in those whose SBP fell more than 20 mm Hg decrease d by two thirds.