Reynolds Kristi, Gu Dongfeng, Muntner Paul, Kusek John W, Chen Jing, Wu Xigui, Duan Xiufang, Chen Chung-Shiuan, Klag Michael J, Whelton Paul K, He Jiang
Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
J Am Soc Nephrol. 2007 Jun;18(6):1928-35. doi: 10.1681/ASN.2006111199. Epub 2007 May 2.
The association between BP and risk for ESRD has not been well characterized in Asian populations. This study examined the relationship between level of BP and incidence of ESRD in a prospective cohort study of 158,365 Chinese men and women who were 40 yr and older. Measurement of BP and covariables were made in 1991 following a standard protocol. Follow-up evaluations were conducted in 1999 to 2000 and included interviewing participants or proxies and obtaining medical records and death certificates for ESRD cases. During 1,236,422 person-years of follow-up, 380 participants initiated renal replacement therapy or died from renal failure (30.7 cases per 100,000 person-years). Compared with those with normal BP, the multivariate adjusted hazard ratios (95% confidence interval) of all-cause ESRD for prehypertension and stage 1 and stage 2 hypertension were 1.30 (0.98 to 1.74), 1.47 (1.06 to 2.06), and 2.60 (1.89 to 3.57), respectively (P < 0.001 for trend). The corresponding hazard ratios (95% confidence interval) of glomerulonephritis-related ESRD were 1.32 (0.82 to 2.11), 1.48 (0.83 to 2.61), and 3.40 (2.02 to 5.74), respectively (P <0.001 for trend). Systolic BP was a stronger predictor of ESRD than diastolic BP or pulse pressure. This study provides novel data on the incidence of ESRD and on the association between BP and glomerulonephritis-related ESRD from a nationally representative sample of adults in China. These results document the importance of high BP as a modifiable risk factor for ESRD in China. Strategies to prevent ESRD should incorporate the prevention, treatment, and control of BP.
血压（BP）与终末期肾病（ESRD）风险之间的关联在亚洲人群中尚未得到充分描述。本研究在一项对158365名40岁及以上中国男性和女性的前瞻性队列研究中，考察了血压水平与ESRD发病率之间的关系。1991年按照标准方案对血压及协变量进行了测量。在1999年至2000年进行了随访评估，包括对参与者或代理人进行访谈，并获取ESRD病例的医疗记录和死亡证明。在1236422人年的随访期间，380名参与者开始接受肾脏替代治疗或死于肾衰竭（每100000人年30.7例）。与血压正常者相比，高血压前期、1期和2期高血压的全因ESRD多变量调整风险比（95%置信区间）分别为1.30（0.98至1.74）、1.47（1.06至2.06）和2.60（1.89至3.57）（趋势P<0.001）。肾小球肾炎相关ESRD的相应风险比（95%置信区间）分别为1.32（0.82至2.11）、1.48（0.83至2.61）和3.40（2.02至5.74）（趋势P<0.001）。收缩压比舒张压或脉压更能预测ESRD。本研究提供了来自中国全国代表性成年人样本的ESRD发病率以及血压与肾小球肾炎相关ESRD之间关联的新数据。这些结果证明了高血压作为中国ESRD可改变风险因素的重要性。预防ESRD的策略应包括血压的预防、治疗和控制。
