Walker W G, Neaton J D, Cutler J A, Neuwirth R, Cohen J D
School of Medicine, Johns Hopkins University, Baltimore, Md.
JAMA. 1992 Dec 2;268(21):3085-91.
To evaluate the contribution of mild to moderate hypertension to progressive loss of renal function by analysis of renal function data from the Multiple Risk Factor Intervention Trial.
The cohort of men with mild to moderate hypertension (baseline diastolic blood pressure > or = 90 mm Hg), randomized to a special intervention (SI) group or usual care (UC) group, were examined for change in renal function based on individual reciprocal creatinine slopes over an average of 7 years' follow-up as the outcome measure. Contribution of blood pressure control during follow-up, age, race, and blood pressure at entry were assessed.
The cohort of 5524 (463 black, 5061 nonblack) hypertensive men receiving no therapy at entry provided the data for the present analysis.
Blood pressure control was similar for black and white participants, but significant decline in reciprocal creatinine slope was found for black men (mean slope, -0.0090 +/- 0.0013 dL/mg/y) compared with white men (+0.0018 +/- 0.0004 dL/mg/y) (P < .001 for difference between blacks and whites). Decline in renal function was also greater among individuals with elevated systolic (P < .001) as well as diastolic blood pressure (P < .001), and older individuals (P < .001). No difference between the SI and UC groups was seen in reciprocal creatinine slopes, but in both groups combined, treatment that maintained diastolic blood pressure below an average value of 95 mm Hg was associated with stable or improving renal function, whereas participants whose blood pressure remained 95 mm Hg or greater continued to decline at -0.0013 +/- 0.0009 dL/mg/y (P = .007 for difference). Separate examination of the subset of black men (n = 463) failed to show such a difference.
Effective blood pressure control was associated with stable or improving renal function in nonblacks but not in blacks. These findings emphasize the importance of blood pressure control to maintain adequate renal function in hypertensive white men and raise important questions about the relationship of pressure reduction and renal function change in blacks.
通过分析多重危险因素干预试验中的肾功能数据，评估轻度至中度高血压对肾功能进行性丧失的影响。
将轻度至中度高血压男性队列（基线舒张压≥90 mmHg）随机分为特殊干预（SI）组或常规护理（UC）组，以个体肌酐倒数斜率的变化作为结局指标，在平均7年的随访期内检查肾功能变化。评估随访期间血压控制情况、年龄、种族和入组时血压的影响。
5524名（463名黑人，5061名非黑人）入组时未接受治疗的高血压男性队列提供了本分析的数据。
黑人和白人参与者的血压控制情况相似，但黑人男性肌酐倒数斜率显著下降（平均斜率为-0.0090±0.0013 dL/mg/年），而白人男性为+0.0018±0.0004 dL/mg/年（黑人和白人之间差异P<0.001）。收缩压升高（P<0.001）以及舒张压升高（P<0.001）的个体和年龄较大的个体（P<0.001）肾功能下降也更明显。SI组和UC组的肌酐倒数斜率未见差异，但在两组合并分析中，舒张压维持在平均95 mmHg以下的治疗与肾功能稳定或改善相关，而血压持续在95 mmHg或更高的参与者肾功能继续以-0.0013±0.0009 dL/mg/年的速度下降（差异P=0.007）。对黑人男性子集（n=463）进行单独分析未显示出这种差异。
有效的血压控制与非黑人的肾功能稳定或改善相关，但与黑人无关。这些发现强调了血压控制对维持高血压白人男性肾功能正常的重要性，并引发了关于黑人降压与肾功能变化关系的重要问题。
