0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial

Johannes F.E. Mann, MD; Hertzel C. Gerstein, MD; Janice Pogue, MSc; Jackie Bosch, MA; Salim Yusuf, MD, HOPE Investigators
[+] Article and Author Information

From McMaster University, Hamilton, Ontario, Canada; Schwabing General Hospital, Ludwig Maximilians University, Munchen, Germany; and the German Institute for High Blood Pressure Research, Heidelberg, Germany.


Grant Support: By the Medical Research Council of Canada, the Ontario Heart Foundation, Aventis, Astra-Zeneca, NEGMA, and the Natural Source Vitamin E Producers Association.

Requests for Single Reprints: Jackie Bosch, MA, HOPE Office, McMaster University, Hamilton General Hospital, 527 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.

Current Author Addresses: Dr. Mann: Department of Nephrology and Hypertension, Schwabing General Hospital, LMU, Kolner Platz 1, D-80804 Munchen, Germany.

Drs. Gerstein, Pogue, and Yusuf and Ms. Bosch: HOPE Office, McMaster University, Hamilton General Hospital, 237 Barton Street East, Hamilton, Ontario L8L 2X2, Canada.

Author Contributions: Conception and design: J.F.E. Mann, H.C. Gerstein, S. Yusuf.

Analysis and interpretation of the data: J.F.E. Mann, H.C. Gerstein, J. Pogue.

Drafting of the article: J.F.E. Mann, H.C. Gerstein, S. Yusuf.

Critical revision of the article for important intellectual content: J.F.E. Mann, H.C. Gerstein, J. Pogue, J. Bosch, S. Yusuf.

Final approval of the article: J.F.E. Mann, H.C. Gerstein, J. Bosch, S. Yusuf.

Provision of study materials or patients: J.F.E. Mann, H.C. Gerstein, J. Bosch.

Statistical expertise: J. Pogue.

Obtaining of funding: H.C. Gerstein, S. Yusuf.

Collection and assembly of data: J.F.E. Mann, J. Bosch.


Ann Intern Med. 2001;134(8):629-636. doi:10.7326/0003-4819-134-8-200104170-00007
Text Size: A A A

The future rate of cardiovascular events can be predicted by several well-established risk factors. Even in the absence of classic risk factors, patients with renal disease have an elevated risk for cardiovascular disease (12). This renal–cardiovascular association is well established in patients with advanced renal insufficiency (2). It has also been reported in patients in the Hypertension Detection and Follow-up Program (HDFP) (3), in which a serum creatinine concentration greater than 133 µmol/L (1.5 mg/dL) was a strong predictor of cardiovascular disease. However, HDFP included only patients with hypertension. In contrast, a recent analysis of data from the Framingham Study did not detect a relationship between mild renal insufficiency (defined as a serum creatinine concentration of 124 to 265 µmol/L [1.4 to 3.0 mg/dL]) and cardiovascular events (4).

First Page Preview

View Large
First page PDF preview

Figures

Grahic Jump Location
Figure 1.
Primary outcome, myocardial infarction, cardiovascular death, and all death for patients with a serum creatinine concentration less than 1.4 mg/dL (<124 µmol/L) or at least 1.4 mg/dL (≥ 124 µmol/L).
Grahic Jump Location
Grahic Jump Location
Figure 2.
Primary outcome according to quartiles of serum creatinine concentration.PP

Quartiles were <0.93 mg/dL (< 82.2 µmol/L), 0.93 to 1.08 mg/dL (82.2 to 96 µmol/L), 1.09 to 1.22 mg/dL (96.1 to 107.9 µmol/L), and ≥ 1.23 mg/dL (≥ 108 µmol/L). For all patients, risk increased significantly with increasing serum creatinine concentration (risk ratio, 2.34 for a 1-mg/dL [88.4 µmol/L] increase in serum creatinine concentration between quartiles;  < 0.001 for trend). The incidence of the primary outcome was significantly lower in each quartile for patients assigned to ramipril (  < 0.05 to 0.0006).

Grahic Jump Location
Grahic Jump Location
Figure 3.
Primary outcome in patients with serum creatinine concentration less than 1.4 mg/dL (<124 µmol/L) and those with serum creatinine concentration at least 1.4 mg/dL (≥ 124 µmol/L), according to presence of diabetes mellitus and hypertension.
Grahic Jump Location

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Trial of a Drug to Decrease the Risk for Heart Disease in Patients with Mild Kidney Failure

The summary below is from the full report titled “Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial.” It is in the 17 April 2001 issue of Annals of Internal Medicine (volume 134, pages 629-636). The authors are JFE Mann, HC Gerstein, J Pogue, J Bosch, and S Yusuf, for the HOPE Investigators.

Read More...

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)