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Olle Melander

Principal investigator

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Interaction Between Renal Function and Microalbuminuria for Cardiovascular Risk in Hypertension The Nordic Diltiazem Study


  • Patrik Svensson
  • Bjorn Wahlstrand
  • Peter Almgren
  • Stanko Skrtic
  • Jan Lanke
  • Lars Weiss
  • Sverre Kjeldsen
  • Thomas Hedner
  • Olle Melander

Summary, in English

We investigated whether renal function and microalbuminuria are independent predictors and whether any interaction exists between them, regarding future cardiovascular disease in hypertensive patients (n=10 881) followed for 4.5 years. The primary end points (PEs) were fatal and nonfatal myocardial infarction and stroke and other cardiovascular deaths. Creatinine and glomerular filtration rate (GFR), estimated using the formulas of the Modification of Diet in Renal Disease study group and Cockroft and Gault and in a subsample (n=4929) of microalbuminuria and interaction terms of microalbuminuria and renal function, were related to the risk of the PE using Cox proportional hazards model after full adjustment. Increased creatinine (P < 0.001), decreased GFR from Cockroft and Gault (P=0.001), and decreased GFR from the Modification of Diet in Renal Disease study group (P=0.001) were all independent risk factors for the PE. Stepwise exclusion of patients with the poorest renal function excluded the possibility that the relationship between decreasing renal function and the PE was driven only by patients with severely impaired renal function. Microalbuminuria and all 3 of the indices of renal function predicted the PE independent of each other. There was a significant interaction between microalbuminuria and GFR from Cockroft and Gault (P=0.040) in prediction of the PE. Both renal function and microalbuminuria add independent prognostic information regarding cardiovascular risk in hypertensive patients. The cardiovascular risk associated with microalbuminuria increases with a decline in GFR, as demonstrated by a significant interaction between microalbuminuria and GFR from Cockroft and Gault. Because estimation of the total cardiovascular risk is essential for the aggressiveness of risk factor interventions, simultaneous inclusion of GFR and microalbuminuria in global cardiovascular risk assessment is essential. (Hypertension. 2008;52:115-122.)


  • Cardiovascular Research - Hypertension
  • Genomics, Diabetes and Endocrinology
  • Department of Statistics

Publishing year












Document type

Journal article


Lippincott Williams & Wilkins


  • Cardiac and Cardiovascular Systems


  • hypertension
  • creatinine
  • glomerular filtration rate
  • cardiovascular risk
  • interaction
  • microalbuminuria



Research group

  • Cardiovascular Research - Hypertension
  • Genomics, Diabetes and Endocrinology


  • ISSN: 1524-4563