Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
J Hypertens. 2011 May;29(5):953-60. doi: 10.1097/HJH.0b013e328344d9cf.
Chronic kidney disease (CKD) is a serious disorder with significant public health impact. Identification of factors associated with risk of progression of kidney disease may help in earlier intervention in high-risk groups. We investigated whether brachial pulse pressure (PP) was associated with 5-year changes in estimated glomerular filtration rate (eGFR) and incident CKD and whether type 2 diabetes modified these associations.
In the population-based Australian Diabetes, Obesity and Lifestyle Study (AusDiab) 5554 individuals (5.8% with type 2 diabetes) who took part in the 5-year follow-up and had no CKD or microalbuminuria at baseline were included.
After adjusting for baseline age, sex, eGFR and use of blood pressure-lowering medication, each baseline SD higher PP was associated with a decline in eGFR of 0.32 ml/min (P=0.006) and an odds ratio (OR) for CKD of 1.29 [95% confidence interval (CI) 1.09-1.53] in individuals without type 2 diabetes. In individuals with type 2 diabetes, eGFR declined by 1.10 ml/min (P=0.011) and the OR for incident CKD was 1.94 (1.14-3.29). Similar associations with eGFR decline were observed with systolic blood pressure and incident CKD in individuals without type 2 diabetes. In individuals with type 2 diabetes, higher systolic blood pressure was only significantly associated with eGFR decline if the diastolic blood pressure was 70 mmHg or less (P for interaction between systolic and diastolic blood pressure: 0.033).
PP is an important risk factor for eGFR decline and incident CKD over a 5-year period, especially in individuals with type 2 diabetes.
慢性肾脏病（CKD）是一种严重的疾病，对公共健康有重大影响。识别与肾脏疾病进展风险相关的因素，可能有助于对高危人群进行早期干预。我们研究了肱动脉脉搏压（PP）是否与 5 年内估算肾小球滤过率（eGFR）的变化以及 CKD 的发生有关，以及 2 型糖尿病是否改变了这些关联。
在基于人群的澳大利亚糖尿病、肥胖和生活方式研究（AusDiab）中，纳入了 5554 名参加了 5 年随访且基线时无 CKD 或微量白蛋白尿的个体（2 型糖尿病患者占 5.8%）。
在校正了基线年龄、性别、eGFR 和使用降压药物后，每个基线 SD 更高的 PP 与 eGFR 的下降相关，下降 0.32 ml/min（P=0.006），无 2 型糖尿病个体的 CKD 比值比（OR）为 1.29（95%置信区间 [CI] 1.09-1.53）。在 2 型糖尿病患者中，eGFR 下降 1.10 ml/min（P=0.011），新发 CKD 的 OR 为 1.94（1.14-3.29）。在无 2 型糖尿病患者中，收缩压与 eGFR 下降和新发 CKD 也存在类似的关联。在 2 型糖尿病患者中，如果舒张压为 70 mmHg 或更低，较高的收缩压仅与 eGFR 下降显著相关（收缩压和舒张压之间的交互作用的 P 值：0.033）。
PP 是 eGFR 下降和 5 年内新发 CKD 的重要危险因素，尤其是在 2 型糖尿病患者中。
