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was higher in patients with CKD as compared to patients with normal GFR. Multivariate
logistic regression analysis showed that patients with CKD had a higher risk of LVH and/or
CV events adjusted for eight covariates, and this risk increased by 23% with each 21 mL/
min/1.73 m2 decrease in GFR. CONCLUSIONS: This study shows that CKD is highly preva-
lent in hypertensive type 2 diabetic patients, where it is a strong predictor of CV adverse
outcome. However, awareness of CKD by GPs is low. Equations for calculating estimated
GFR should be included in the GPs' database in order to detect the presence of CKD and
to improve CV outcome of such a high-risk population.
15. Sturkenboom MC, Dieleman JP, Picelli G, Mazzaglia G, Mozaffari E, Filippi A, Cricelli C,
van der Lei J. Prevalence and treatment of hypertensive patients with multiple
concomitant cardiovascular risk factors in The Netherlands and Italy.
J Hum Hyper-
tens. 2008;22:704-13.
ABSTRACT. The Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-
LLA) trial demonstrated the benefits of combined antihypertensive/lipid-lowering treat-
ment over antihypertensive treatment alone in hypertensive patients with >/=3 additional
cardiovascular (CV) risk factors. We assessed the prevalence and treatment of patients
with hypertension and >/=3 additional CV risk factors in The Netherlands and Italy in a
retrospective cohort study using the Integrated Primary Care Information (IPCI) database
in The Netherlands and the Health Search/Thales Database (HSD) in Italy. Patients aged
>/=16 years, with 1 year of valid database history, diagnosed and/or treated for hyperten-
sion (>140/90 mmHg) during 2000-2002 were included in the study. The IPCI and HSD
populations consisted of approximately 175 000 and approximately 325 000 patients,
respectively. The prevalence of hypertension increased from 20.3 to 22.3% in the IPCI,
and from 19.0 to 21.8% in the HSD during 2000-2002. The prevalence of >/=3 conco-
mitant risk factors among hypertensive patients increased from 31.2 and 31.1% in 2000
to 34.2 and 39.3% in 2002 in the IPCI and HSD, respectively. From 2000 to 2002, among
hypertensive patients with >/=3 CV risk factors and no prior symptomatic CV disease
(CVD) approximately 54-57% in the IPCI and 80-83% in the HSD received antihypertensi-
ve treatment. In these patients, the use of combined antihypertensive and lipid-lowering
treatment increased from 14.2 to 17.6% in the IPCI and from 15.5 to 17.4% in the HSD
from 2000 to 2002. This study shows that primary prevention of CVD in hypertensive
patients in The Netherlands and Italy could be improved.
16. Minutolo R, De Nicola L, Mazzaglia G, Postorino M Cricelli C, Mantovani LG, Conte G,
Cianciaruso B. Detection and Awareness of Moderate to Advanced CKD by Primary
Care Practitioners: A Cross-sectional Study From Italy
. Am J Kidney Dis. 2008;52:444-
ABSTRACT. BACKGROUND: Chronic kidney disease (CKD) is a strong independent pre-
dictor of cardiovascular disease. Although general practitioners (GPs) represent the first
line for identification of these high-risk patients, their diagnostic approach to CKD is ill
defined. STUDY DESIGN: Cross-sectional evaluation of database of Italian GPs. SETTING
& PARTICIPANTS: Representative sample of adult Italian population regularly followed up
by GPs in 2003. OUTCOMES: Frequency of serum creatinine testing, prevalence of CKD
(estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)), awareness of CKD
assessed from use of diagnostic codes (Classification of Diseases, Ninth Revision, Clinical
Modification [ICD-9-CM]) for CKD, and referral to nephrologists. RESULTS: Of 451,548
individuals in the entire practice population, only 77,630 (17.2%) underwent serum cre-
atinine testing. Female sex (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.06 to
1.12), advanced age (OR, 2.70; 95% CI, 2.63 to 2.78), diabetes (OR, 1.31; 95% CI, 1.20
to 1.42), hypertension (OR, 1.10; 95% CI, 1.02 to 1.19), autoimmune diseases (OR, 1.42;