DIURETIC-BASED TREATMENT AND CARDIOVASCULAR EVENTS IN PATIENTS WITH MILD RENAL DYSFUNCTION ENROLLED IN THE SYSTOLIC HYPERTENSION IN THE ELDERLY PROGRAM

Background: It is expected that the treatment of hypertension in patie nts with renal disease decreases the risk of cardiovascular events, bu t the evidence in these patients is lacking. Objective: To assess the effect of diuretic-based treatment on cardiovascular events in patient s with isolated systolic hypertension and renal dysfunction. Methods: A total of 4336 persons aged 60 years and older with systolic blood pr essures of 160 mm Hg and higher and diastolic blood pressures of less than 90 mm Hg were randomly assigned to receive either placebo or chlo rthalidone (12.5-25.0 mg/d), with the addition of atenolol (25-50 mg/d ) or reserpine (0.05-0.10 mg/d) if needed, and observed for 5 years. T he risk of first-occurring cardiovascular events, including stroke, tr ansient ischemic attack, myocardial infarction, heart failure, coronar y artery bypass surgery, angioplasty, aneurysm, endarterectomy, sudden death, or rapid death, was stratified according to baseline serum cre atinine levels (35.4-84.0, 84.1-101.6, 101.7-119.3, and 119.4-212.2 mu mol/L [0.4-0.9, 1.0-1.1, 1.2-1.3, and 1.4-2.4 mg/dL]). Results: Systo lic blood pressure reduction was not affected by baseline serum creati nine levels. Active treatment did not affect the risk of serum creatin ine levels becoming elevated during follow-up. The risk of hypokalemia with active treatment decreased significantly with increasing baselin e serum creatinine levels. In the 4 baseline serum creatinine groups, the relative risk (95% confidence interval) of cardiovascular events d eveloping with active treatment was 0.73 (0.54-0.97), 0.63 (0.49-0.82) , 0.62 (0.44-0.87), and 0.59 (0.38-0.91), The results were similar for the outcomes of stroke or coronary artery events and in analyses stra tified by sex or age. Conclusion: Diuretic-based treatment of patients with isolated systolic hypertension prevents the development of cardi ovascular events in older persons with mild renal dysfunction.