Edwards Matthew S, Hansen Kimberley J, Craven Timothy E, Cherr Gregory S, Bleyer Anthony J, Burke Gregory L, Dean Richard H
Division of Surgical Sciences Section on Vascular Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1095, USA.
Am J Kidney Dis. 2003 May;41(5):990-6. doi: 10.1016/s0272-6386(03)00196-3.
The purpose of this study is to examine the associations between renovascular disease (RVD) and cross-sectional measures of blood pressure and renal function among participants in the Cardiovascular Health Study (CHS).
The CHS is a prospective cohort study of cardiovascular disease among elderly Americans. As part of an ancillary study, participants in the Forsyth County, NC, cohort of the CHS were invited to undergo renal duplex sonography (RDS) to define the presence or absence of RVD (defined as any focal peak systolic velocity > or = 1.8 milliseconds or the absence of a Doppler shifted signal from an imaged artery). Demographic, risk factor, blood pressure, and serum creatinine data were obtained at the time of RDS and from the annual CHS examination.
Eight hundred thirty-four CHS participants (including 525 women [63%], 309 men [37%], 194 African Americans [23%], and 635 Caucasians [76%]) with a mean age of 77.2 +/- 4.9 years underwent successful RDS. RVD was present in 57 participants (6.8%). When examined according to the presence or absence of RVD, significant univariate differences were observed in the prevalence of clinical hypertension (72% versus 50%; P = 0.001), systolic blood pressure (145 versus 136 mm Hg; P = 0.001), and renal insufficiency (16% versus 8%; P = 0.041). Multivariate analyses showed significant and independent associations for the presence of RVD with increasing systolic blood pressure (P = 0.034), clinical hypertension (odds ratio, 2.68; 95% confidence interval, 1.44 to 4.99; P = 0.002), increasing serum creatinine level, and renal insufficiency (odds ratio, 2.21; 95% confidence interval, 1.02 to 4.79; P = 0.043). A significant interaction was observed between the presence of RVD and increasing systolic blood pressure in association with increasing serum creatinine levels (P = 0.041).
These results suggest important population-based associations between RVD and cross-sectional measures of blood pressure and renal function. Furthermore, the observed relationship between RVD and increasing serum creatinine level was influenced strongly by increasing blood pressure.
本研究旨在探讨心血管健康研究（CHS）参与者中肾血管疾病（RVD）与血压及肾功能横断面测量值之间的关联。
CHS是一项针对美国老年人心血管疾病的前瞻性队列研究。作为一项辅助研究的一部分，邀请了CHS北卡罗来纳州福赛斯县队列的参与者接受肾脏双功超声检查（RDS），以确定是否存在RVD（定义为任何局灶性收缩期峰值速度≥1.8米/秒或成像动脉无多普勒频移信号）。在进行RDS时以及从CHS年度检查中获取人口统计学、危险因素、血压和血清肌酐数据。
834名CHS参与者（包括525名女性[63%]、309名男性[37%]、194名非裔美国人[23%]和635名白种人[76%]），平均年龄为77.2±4.9岁，成功接受了RDS检查。57名参与者（6.8%）存在RVD。根据是否存在RVD进行检查时，临床高血压患病率（72%对50%；P = 0.001）、收缩压（145对136 mmHg；P = 0.001）和肾功能不全患病率（16%对8%；P = 0.041）存在显著的单因素差异。多变量分析显示，RVD的存在与收缩压升高（P = 0.034）、临床高血压（比值比，2.68；95%置信区间，1.44至4.99；P = 0.002）、血清肌酐水平升高以及肾功能不全（比值比，2.21；95%置信区间，1.02至4.79；P = 0.043）之间存在显著且独立的关联。观察到RVD的存在与收缩压升高以及血清肌酐水平升高之间存在显著的交互作用（P = 0.041）。
这些结果表明，基于人群的RVD与血压及肾功能横断面测量值之间存在重要关联。此外，观察到的RVD与血清肌酐水平升高之间的关系受到血压升高的强烈影响。
