Department of Internal Medicine, School of Medicine, Keio University, Shinjuku-ku, Tokyo, Japan.
Hypertens Res. 2010 Nov;33(11):1211-20. doi: 10.1038/hr.2010.162. Epub 2010 Sep 16.
This study evaluated the impact of renal function on cardiovascular outcomes in elderly hypertensive patients enrolled in the Japanese Trial to Assess Optimal Systolic Blood Pressure in Elderly Hypertensive patients. The patients were randomly assigned to either a strict-treatment group (target systolic blood pressure (BP) <140 mm Hg, n=2212) or a mild-treatment group (target systolic BP, 140 to <160 mm Hg, n=2206), each with efonidipine (a T/L-type Ca channel blocker)-based regimens. Cardiovascular events (stroke, cardiovascular disease and renal disease) were evaluated during the 2-year follow-up period following the prospective randomized open-blinded end-point method. Estimated glomerular filtration rate (eGFR) was elevated throughout the trial period in both the strict-treatment (59.4-62 ml min⁻¹ per 1.73 m²) and the mild-treatment group (58.8-61.4 ml min⁻¹ per 1.73 m²). This tendency was also observed in diabetic patients and patients aged ≥75 years, with baseline eGFR<60 ml min⁻¹ per 1.73 m². Baseline eGFR (<60 vs. ≥60 ml min⁻¹ per 1.73 m²) had no definite relationship with the incidence of cardiovascular events, nor did the level of BP control. Proteinuria at the time of entry into the study, however, was significantly correlated with cardiovascular event rates (7.1%), an association that was more apparent in patients with eGFR<60 ml min⁻¹ per 1.73 m² (8.2%). Furthermore, the event rate was more elevated in patients with greater declines in eGFR and was amplified when the baseline eGFR was <60 ml min⁻¹ per 1.73 m². In conclusion, the rates of decline of renal function and proteinuria constitute critical risk factors for cardiovascular events in elderly hypertensive patients, trends that are enhanced when baseline eGFR is diminished. Furthermore, the fact that efonidipine-based regimens ameliorate renal function in elderly hypertensive patients with chronic kidney disease may offer novel information on the mechanisms of cardiovascular protection.
这项研究评估了肾功能对参加日本老年高血压患者最佳收缩压评估试验（JATOS）的老年高血压患者心血管结局的影响。这些患者被随机分为严格治疗组（目标收缩压（BP）<140mmHg，n=2212）或轻度治疗组（目标收缩压 140-<160mmHg，n=2206），每组均接受依福地平（一种 T/L 型钙通道阻滞剂）为基础的治疗方案。在前瞻性随机开放盲终点法的 2 年随访期间，评估了心血管事件（中风、心血管疾病和肾脏疾病）。在整个试验期间，严格治疗组（59.4-62ml/min/1.73m²）和轻度治疗组（58.8-61.4ml/min/1.73m²）的估计肾小球滤过率（eGFR）均升高。这种趋势在糖尿病患者和年龄≥75 岁且基线 eGFR<60ml/min/1.73m²的患者中也观察到。基线 eGFR（<60 与≥60ml/min/1.73m²）与心血管事件的发生率之间没有明确的关系，血压控制水平也没有。然而，研究开始时的蛋白尿与心血管事件发生率（7.1%）显著相关，这种关联在 eGFR<60ml/min/1.73m²的患者中更为明显（8.2%）。此外，eGFR 下降幅度较大的患者事件发生率更高，当基线 eGFR<60ml/min/1.73m²时，这种情况更为明显。总之，肾功能和蛋白尿的下降速度是老年高血压患者心血管事件的关键危险因素，当基线 eGFR 降低时，这些趋势会增强。此外，依福地平为基础的治疗方案可改善慢性肾脏病老年高血压患者的肾功能，这可能为心血管保护的机制提供新的信息。
