State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Vascular Biology, Vascular Evaluation Center and Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Hypertens Res. 2012 Feb;35(2):201-6. doi: 10.1038/hr.2011.167. Epub 2011 Oct 20.
Arterial stiffness exemplified by the ambulatory arterial stiffness index (AASI) and pulse pressure (PP) predicts cardiovascular morbidity and mortality. The present cross-sectional study assessed the association of renal function with AASI and 24-h PP in hypertensive inpatients. Subjects included 948 hypertensive inpatients with drug treatment (mean age, 53.3 years; male, 67.1%). The AASI was defined as 1 minus the regression slope of diastolic over systolic blood pressure readings obtained from 24-h recordings. Renal function was evaluated by serum creatinine and urinary albumin excretion was expressed by the urinary albumin-to-urinary creatinine ratio (ACR), and estimated glomerular filtration rate (eGFR) was calculated by the modification of diet in renal disease formula and chronic kidney disease-epidemiology collaboration formula. As AASI and 24-h PP increased, serum creatinine concentrations and ACR increased, and eGFR decreased. Multiple linear regression showed that AASI and 24-h PP were associated with eGFR-EPI (B=-12.00, P=0.001 vs. B=-0.14, P=0.002) and ACR (B=0.56, P=0.004 vs. B=0.01, P=0.017) independent of other cardiovascular risk factors. After additional adjustment for 24-h PP, the association of AASI with eGFR-EPI had borderline significance (P=0.053), whereas the significant associations of 24-h PP with serum creatinine and ACR persisted (P=0.009 and P=0.006) after adjusting for confounding factors and AASI. Multiple logistic regression analysis showed that each s.d. increase in 24-h PP (that is, 13 mm Hg) was associated with a higher risk of suffering from microalbuminuria (MA) by 39% (P=0.038) after additional adjustment for AASI. In conclusion, AASI is more closely associated with eGFR compared with 24-h PP in hypertensive inpatients. However, for MA 24-h PP is a better predictor.
动脉僵硬度以动态血压动脉僵硬度指数（AASI）和脉压（PP）为代表，可预测心血管发病率和死亡率。本横断面研究评估了肾功能与高血压住院患者的 AASI 和 24 小时 PP 的相关性。研究对象包括 948 名接受药物治疗的高血压住院患者（平均年龄 53.3 岁，男性占 67.1%）。AASI 定义为 24 小时记录的舒张压与收缩压读数回归斜率的倒数。肾功能通过血清肌酐评估，尿白蛋白排泄用尿白蛋白/尿肌酐比值（ACR）表示，通过肾脏病饮食改良公式和慢性肾脏病-流行病学合作公式计算估计肾小球滤过率（eGFR）。随着 AASI 和 24 小时 PP 的增加，血清肌酐浓度和 ACR 增加，eGFR 降低。多元线性回归显示，AASI 和 24 小时 PP 与 eGFR-EPI（B=-12.00，P=0.001 与 B=-0.14，P=0.002）和 ACR（B=0.56，P=0.004 与 B=0.01，P=0.017）独立相关，不受其他心血管危险因素影响。在进一步调整 24 小时 PP 后，AASI 与 eGFR-EPI 的相关性具有边缘显著性（P=0.053），而 24 小时 PP 与血清肌酐和 ACR 的显著相关性在调整混杂因素和 AASI 后仍然存在（P=0.009 和 P=0.006）。多因素逻辑回归分析显示，24 小时 PP 每增加 1 个标准差（即 13mmHg），在进一步调整 AASI 后，患微量白蛋白尿（MA）的风险增加 39%（P=0.038）。总之，与 24 小时 PP 相比，AASI 在高血压住院患者中与 eGFR 的相关性更强。然而，对于 MA，24 小时 PP 是一个更好的预测指标。
