Impact of previous diagnosis of hypertension on renal function in heart failure patients

Objective: The aim of this study is to evaluate the impact of previous diagnosis of HTN in the reduction of the estimated glomerular filtration rate (eGFR) and the development of chronic kidney disease (CKD) in heart failure (HF) patients by using real world data. Design and method: The study population was selected from a database with electronic health records information from 2012 to 2016 of patients older than 24 years of age. Patients with an active diagnosis of HF at some point during this period were selected, and then stratified according to the presence of previous diagnosis of hypertension. eGFR and Kidney Disease Global Outcomes (KDIGO) risk scale during the observational period were analyzed. Two events were studied using survival and Cox proportional hazards regression models: i) reduction of 20% compared to basal eGFR value and ii) increased risk in the KDIGO scale. Other clinically relevant factors were selected as adjustment variables: age, sex, comorbidities (atrial fibrillation, diabetes, dyslipidaemia and coronary heart disease) and drugs used for HF treatment or anticoagulation. Results: The study population included 80631 HF patients, 37426 of them classified with the KDIGO scale. The proportion of patients with hypertension was 87% and the mean baseline eGFR was 64.2 ml/min/1.73m 2 . The average age was 75.63 years and 54.7% women. Significant increments in risk were found in patients diagnosed of hypertension for the two events, being 1.28 (CI95% 1.21–1.36) for the eGFR reduction and 1.36 (CI95% 1.25–1.48) for the KDIGO increased risk (Figures). This effect increased as the baseline CKD risk was higher, with 1.45 (CI95% 1.37–1.53) times the risk in the case of base high-risk group (eGFR at baseline <60ml/min/1.73m 2 ; N = 5980) compared to the low risk one (N = 15460). Conclusions: Hypertension is a very prevalent comorbidity of patients with HF, and has a negative impact on kidney function, increasing the risk of reduction of eGFR and development of CKD. The prognosis is significantly worse as the baseline risk is higher.