University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK.
J Hypertens. 2012 May;30(5):974-9. doi: 10.1097/HJH.0b013e3283526e47.
To investigate the impact of pulse pressure at presentation on the primary outcome (death or dialysis) in patients with malignant phase hypertension (MPH).
Three hundred and sixty-five patients [overall mean (SD) age 48 (13) years; 66% male; 63% white European; 23% African-Caribbean, 14% south Asian] from the West Birmingham MPH study were included. Baseline pulse pressure was divided into quartiles. Two hundred and forty-two primary outcomes (death or dialysis) occurred during a median (interquartile range) follow-up of 7 (1.5-14.8) years.
Significantly higher pulse pressure was evident among older patients and white Europeans. Baseline BMI (P = 0.49), retinopathy (P = 0.56), proteinuria (P = 0.61), haematuria (P = 0.56) and left ventricular hypertrophy (P = 0.43) were not related to pulse pressure. Multivariate analyses found that baseline age [hazard ratio (95% confidence intervals] [1.05 (1.04-1.06); P < 0.0001], smoking [1.60 (1.16-2.21); P = 0.004], proteinuria [1.33 (1.10-1.61); P = 0.003] and creatinine level [1.002 (1.001-1.002); P < 0.0001] were independent predictors of the primary outcome of 'death or dialysis'. A multivariate analysis also revealed that independent predictors of future dialysis alone were as follows: baseline age [0.92 (0.89-0.95); P < 0.001) and haematuria [2.74 (1.17-6.42); P = 0.02), with a trend seen for baseline creatinine levels [1.001 (1.000-1.002); P = 0.052)]. Pulse pressure at baseline did not predict death or dialysis.
Age, smoking status and severity of renal failure at presentation with MPH (represented by proteinuria and creatinine levels) are independent predictors of the risk of death or dialysis. Pulse pressure at presentation does not predict death or dialysis in patients with MPH. Careful monitoring of renal functioning and effective management of blood pressure is mandatory in patients with MPH to prevent/slow future complications.
探讨恶性高血压（MPH）患者就诊时的脉压对主要结局（死亡或透析）的影响。
纳入了来自西米德兰兹恶性高血压研究的 365 名患者[总体平均（SD）年龄 48（13）岁；66%为男性；63%为白种欧洲人；23%为非裔加勒比人，14%为南亚人]。将基线脉压分为四分位。中位（四分位间距）随访 7（1.5-14.8）年后，发生了 242 例主要结局（死亡或透析）。
年龄较大的患者和白种欧洲人脉压明显较高。基线 BMI（P=0.49）、视网膜病变（P=0.56）、蛋白尿（P=0.61）、血尿（P=0.56）和左心室肥厚（P=0.43）与脉压无关。多变量分析发现，基线年龄[危险比（95%置信区间）[1.05（1.04-1.06）；P<0.0001]、吸烟[1.60（1.16-2.21）；P=0.004]、蛋白尿[1.33（1.10-1.61）；P=0.003]和肌酐水平[1.002（1.001-1.002）；P<0.0001]是主要结局“死亡或透析”的独立预测因素。多变量分析还显示，未来仅透析的独立预测因素如下：基线年龄[0.92（0.89-0.95）；P<0.001）和血尿[2.74（1.17-6.42）；P=0.02]，基线肌酐水平呈上升趋势[1.001（1.000-1.002）；P=0.052）]。就诊时的脉压不能预测死亡或透析。
MPH 患者就诊时的年龄、吸烟状况和肾功能衰竭严重程度（以蛋白尿和肌酐水平表示）是死亡或透析风险的独立预测因素。MPH 患者就诊时的脉压不能预测死亡或透析。必须对 MPH 患者进行仔细的肾功能监测和有效的血压管理，以预防/减缓未来的并发症。
