Lifestyle Change Important for Patients With Hypertension and Cardiovascular Diseases

To the Editor:

We read the article “Contribution of Glomerular Filtration Rate to 10‐Year Cardiovascular and Mortality Risk Among Hypertensive Adults: Tehran Lipid and Glucose Study,” written by Reza Mohebi and colleagues with interest.1 They concluded that estimated glomerular filtration rate (eGFR) was shown to be independently associated with cardiovascular disease (CVD) and all‐cause mortality among hypertensive men with or without diabetes. They also observed that, irrespective of diabetes status or sex, when information on traditional CVD risk factors was available, information on eGFR did not provide any additional predictive value for CVD. We believe that these findings will act as a guide for further information regarding chronic kidney disease and CVD risk factors in patients with essential hypertension. Thanks to the authors for their valuable contribution.

As we know, hypertension is quite common and is a preventable public health problem, which is one of the major causes of death. It has been shown to be very important in the development of CVD‐related deaths, especially in recent studies.2

Increased endothelial dysfunction, vascular inflammation, and atherosclerosis have mainly been blamed for the development of CVD. Chronic renal failure is quite common and is recently frequently seen together with increased CVD risks.3 In this study, a relationship between eGFR and the presence of CVD and all‐cause mortality is discussed in male hypertensive patients. However, the demographic data of the patients in the study seems to be a bit superficial. As an example, because cigarette smoking has a very strong association with CVD,4 it would be better if the pack per year was given instead of just classifying smoking rates as daily and occasional. Thus, those patients would be understood to be heavy smokers or light smokers. However, alcohol intake, holding an especially important place in the development of CVD, was not mentioned and it is not clear whether the group drank alcohol heavily or socially. In addition, a change in lifestyle was applied to a portion of patients; however, what level and how they were implemented; how much exercise they performed, ie, how many days a week; and whether there were any restrictions in salt intake was not mentioned.5 Clearing the difference between these patients and patients who received lifestyle changes would add more to the study results.

In addition, whether the patients with hyperlipidemia had lipid‐lowering therapy, especially whether they used a statin, was not specified in the demographic data. It is known that statins and other lipid‐lowering drugs have pleotropic effects on CVD development and cause a reduction in mortality rates.6

When the Tables I and II are examined, it is understood that the average age, body mass index, blood pressures, and levels of lipids of the patients examined were not statistically homogeneous. Creating a more homogeneous group should provide more accurate data.

Some patients appear to be pretty badly controlled, especially in terms of blood pressure. In particular, the objectives of the group 1 and 2 attained in Table I do not have target blood pressure values. Again, diabetic patients lack the valuable information of glycated hemoglobin, which is especially important in terms of the quality of glycemic regulation in these patients, leading to a lack of evaluation of CVD risk and mortality.

It is recognized that there is an independent relationship between CVD and eGFR in hypertensive patients, and this is associated with death in men.