Department of Medicine, Division of Nephrology, Duke University Medical Center, Box 3646, Durham, NC 27710, USA.
Circulation. 2010 May 25;121(20):2183-91. doi: 10.1161/CIRCULATIONAHA.109.896597. Epub 2010 May 10.
Little is known about the association of kidney dysfunction and outcome in acute severe hypertension. This study aimed to measure the association between baseline chronic kidney disease (estimated glomerular filtration rate), acute kidney injury (AKI, decrease in estimated glomerular filtration rate > or =25% from baseline) and outcome in patients hospitalized with acute severe hypertension.
The Studying the Treatment of Acute Hypertension (STAT) registry enrolled patients with acute severe hypertension, defined as > or =1 blood pressure measurement >180 mm Hg systolic and/or >110 mm Hg diastolic and treated with intravenous antihypertensive therapy. Data were compared across groups categorized by admission estimated glomerular filtration rate and AKI during admission. On admission, 79% of the cohort (n=1566) had at least mild chronic kidney disease (estimated glomerular filtration rate <60 mL/min in 46%, <30 mL/min in 22%). Chronic kidney disease patients were more likely to develop heart failure (P<0.0001), non-ST-elevation myocardial infarction (P=0.003), and AKI (P<0.007). AKI patients were at greater risk of heart failure and cardiac arrest (P< or =0.0001 for both). Subjects with AKI experienced higher mortality at 90 days (P=0.003). Any acute loss of estimated glomerular filtration rate during hospitalization was independently associated with an increased risk of death (odds ratio, 1.05; P=0.03 per 10-mL/min decline). Other independent predictors of mortality included increasing age (P<0.0001), male gender (P=0.016), white versus black race (P=0.003), and worse baseline kidney function (P=0.003).
Chronic kidney disease is a common comorbidity among patients admitted with acute severe hypertension, and AKI is a frequent form of acute target organ dysfunction, particularly in those with baseline chronic kidney disease. Any degree of AKI is associated with a greater risk of morbidity and mortality.
肾脏功能障碍与急性重度高血压的预后之间的关联知之甚少。本研究旨在评估基线慢性肾脏病（估算肾小球滤过率）、急性肾损伤（AKI，与基线相比估算肾小球滤过率下降≥25%）与因急性重度高血压住院患者预后之间的关联。
急性重度高血压治疗研究（STAT）登记研究纳入了急性重度高血压患者，定义为≥1 次血压测量值收缩压>180mmHg 和/或舒张压>110mmHg，并且接受了静脉降压治疗。根据入院时估算肾小球滤过率和入院期间 AKI 对患者进行分组，比较各组间的数据。入院时，队列中有 79%（n=1566）的患者至少患有轻度慢性肾脏病（估算肾小球滤过率<60mL/min 占 46%，<30mL/min 占 22%）。慢性肾脏病患者更易发生心力衰竭（P<0.0001）、非 ST 段抬高型心肌梗死（P=0.003）和 AKI（P<0.007）。AKI 患者发生心力衰竭和心脏骤停的风险更高（P<或=0.0001）。入院期间估算肾小球滤过率发生任何急性损失与 90 天死亡率升高相关（每下降 10mL/min，比值比为 1.05；P=0.03）。死亡率的其他独立预测因素包括年龄增加（P<0.0001）、男性（P=0.016）、白种人而非黑种人（P=0.003）以及基线肾功能更差（P=0.003）。
慢性肾脏病是因急性重度高血压入院患者的常见合并症，AKI 是急性靶器官功能障碍的常见形式，尤其是在基线有慢性肾脏病的患者中。任何程度的 AKI 都与更高的发病率和死亡率相关。
