We all have been educated numerous times about the need to control hypertension in all patients with that diagnosis. This is particularly in patients with heart failure (HF), where kidney function plays an important role in how well we can control blood pressure. Recently, a causal mediation analysis (using estimated glomerular filtration rate [eGFR] as the mediator) of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Lower Heart Attack) trial data was performed to look at the relationship between blood pressure control, HF, and kidney function.
Within the data, there were more than 1700 incident HF events—with 1359 hospitalizations/fatal HF events. Analysis of this revealed that a relative change in eGFR was related to the effect of antihypertensive agents in HF. The authors concluded that the eGFR change was responsible for 50% of the effect of antihypertensive agents in HF on the risk difference scale. The drugs noted to be mediated by eGFR in the analysis were chlorthalidone and lisinopril, as compared with amlodipine and doxazosin.
The bottom line is that placing your patients on antihypertension medications and getting appropriate control can directly impact HF prevention: As the patient’s renal function worsens due to lack of adequate blood pressure control, the greater their risk for incident symptomatic HF. As practitioners, we must work with our patients to help control comorbidities and, thus, mitigate some of the potentially harmful impacts of disease.