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The overdriven glomerulus as a cardiovascular risk factor. In a large cohort of patients referred for the diagnosis of hypertension by ambulatory blood pressure monitoring, the risk for cardiovascular events associated with glomerular hyperfiltration (hazard ratio: 1.53) was higher than that associated with diabetes (hazard ratio: 1.43) or with a 10 mm Hg higher 24-hour systolic blood pressure (hazard ratio: 1.37) and was identical to that by smoking (hazard ratio: 1.53). Reducing glomerular hyperfiltration may improve cardiovascular outcomes in hypertensive patients, an issue that remains to be tested in appropriate randomized clinical trials.