Ishikawa Joji, Shimizu Motohiro, Hoshide Satoshi, Eguchi Kazuo, Pickering Thomas G, Shimada Kazuyuki, Kario Kazuomi
Division of Cardiovascular Medicine, Department of Internal Medicine, Jichi Medical University School of Medicine, Tochigi, Japan.
J Clin Hypertens (Greenwich). 2008 Oct;10(10):787-94. doi: 10.1111/j.1751-7176.2008.00018.x.
Chronic kidney disease (CKD) increases the risk of cardiovascular events and is often associated with the nondipping pattern of blood pressure (BP). We evaluated ambulatory BP, CKD, and the incidence of cardiovascular events in 811 older hypertensive patients. CKD and the dipping pattern increased the risk of cardiovascular events independent of the 24-hour systolic BP level (CKD: hazard ratio [HR], 2.37; 95% confidence interval [CI], 1.24-4.54; nondippers: HR, 2.16; 95% CI, 1.19-3.91; extreme dippers: HR, 2.38; 95% CI, 1.17-4.83). However, after adjustment for covariates that included CKD, the risk in nondippers was insignificant (HR, 1.83; 95% CI, 0.998-3.34; P=.051), while the risk in extreme dippers remained (HR, 2.59; 95% CI, 1.26-5.32; P=.009) (CKD: HR, 1.81; 95% CI, 0.93-3.54; P=.081). Patients with CKD have an increased risk of cardiovascular events. CKD and other cardiovascular risk factors may account for some of the increased risk in nondippers, but it does not explain the higher risk in extreme dippers.
慢性肾脏病（CKD）会增加心血管事件的风险，且常与血压（BP）的非勺型模式相关。我们评估了811例老年高血压患者的动态血压、CKD及心血管事件的发生率。CKD和勺型模式增加了心血管事件的风险，且独立于24小时收缩压水平（CKD：风险比[HR]，2.37；95%置信区间[CI]，1.24 - 4.54；非勺型：HR，2.16；95% CI，1.19 - 3.91；极端勺型：HR，2.38；95% CI，1.17 - 4.83）。然而，在对包括CKD在内的协变量进行校正后，非勺型患者的风险无统计学意义（HR，1.83；95% CI，0.998 - 3.34；P = 0.051），而极端勺型患者的风险仍然存在（HR，2.59；95% CI，1.26 - 5.32；P = 0.009）（CKD：HR，1.81；95% CI，0.93 - 3.54；P = 0.081）。CKD患者发生心血管事件的风险增加。CKD和其他心血管危险因素可能是部分非勺型患者风险增加的原因，但无法解释极端勺型患者风险更高的现象。
