CKD 患者中明显治疗抵抗性高血压的患病率。
Prevalence of apparent treatment-resistant hypertension among individuals with CKD.
机构信息
Department of Epidemiology, University of Alabama, Birmingham, Alabama, USA.
出版信息
Clin J Am Soc Nephrol. 2013 Sep;8(9):1583-90. doi: 10.2215/CJN.00550113. Epub 2013 Jul 18.
BACKGROUND AND OBJECTIVES
Apparent treatment-resistant hypertension is defined as systolic/diastolic BP ≥ 140/90 mmHg with concurrent use of three or more antihypertensive medication classes or use of four or more antihypertensive medication classes regardless of BP level.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The prevalence of apparent treatment-resistant hypertension among Reasons for Geographic and Racial Differences in Stroke study participants treated for hypertension (n=10,700) was determined by level of estimated GFR and albumin-to-creatinine ratio, and correlates of apparent treatment-resistant hypertension among those participants with CKD were evaluated. CKD was defined as an albumin-to-creatinine ratio ≥ 30 mg/g or estimated GFR<60 ml/min per 1.73 m(2).
RESULTS
The prevalence of apparent treatment-resistant hypertension was 15.8%, 24.9%, and 33.4% for those participants with estimated GFR ≥ 60, 45-59, and <45 ml/min per 1.73 m(2), respectively, and 12.1%, 20.8%, 27.7%, and 48.3% for albumin-to-creatinine ratio<10, 10-29, 30-299, and ≥ 300 mg/g, respectively. The multivariable-adjusted prevalence ratios (95% confidence intervals) for apparent treatment-resistant hypertension were 1.25 (1.11 to 1.41) and 1.20 (1.04 to 1.37) for estimated GFR levels of 45-59 and <45 ml/min per 1.73 m(2), respectively, versus ≥ 60 ml/min per 1.73 m(2) and 1.54 (1.39 to 1.71), 1.76 (1.57 to 1.97), and 2.44 (2.12 to 2.81) for albumin-to-creatinine ratio levels of 10-29, 30-299, and ≥ 300 mg/g, respectively, versus albumin-to-creatinine ratio<10 mg/g. After multivariable adjustment, men, black race, larger waist circumference, diabetes, history of myocardial infarction or stroke, statin use, and lower estimated GFR and higher albumin-to-creatinine ratio levels were associated with apparent treatment-resistant hypertension among individuals with CKD.
CONCLUSIONS
This study highlights the high prevalence of apparent treatment-resistant hypertension among individuals with CKD.
背景与目的
显性治疗抵抗性高血压定义为在同时使用三种或更多种降压药物类别或使用四种或更多种降压药物类别的情况下，收缩压/舒张压≥140/90mmHg，无论血压水平如何。
设计、设置、参与者和测量：通过估计肾小球滤过率（eGFR）和白蛋白/肌酐比值的水平，确定 Reasons for Geographic and Racial Differences in Stroke 研究中接受高血压治疗的参与者（n=10700）中显性治疗抵抗性高血压的患病率，并评估这些患有 CKD 的参与者中显性治疗抵抗性高血压的相关因素。CKD 的定义为白蛋白/肌酐比值≥30mg/g 或 eGFR<60ml/min/1.73m²。
结果
eGFR 分别为≥60、45-59 和<45ml/min/1.73m²的参与者中，显性治疗抵抗性高血压的患病率分别为 15.8%、24.9%和 33.4%，白蛋白/肌酐比值分别为<10、10-29、30-299 和≥300mg/g 的参与者中，显性治疗抵抗性高血压的患病率分别为 12.1%、20.8%、27.7%和 48.3%。eGFR 水平为 45-59 和<45ml/min/1.73m²的参与者中，显性治疗抵抗性高血压的多变量调整后患病率比（95%置信区间）分别为 1.25（1.11 至 1.41）和 1.20（1.04 至 1.37），与 eGFR≥60ml/min/1.73m²相比；白蛋白/肌酐比值分别为 10-29、30-299 和≥300mg/g 的参与者中，显性治疗抵抗性高血压的多变量调整后患病率比（95%置信区间）分别为 1.54（1.39 至 1.71）、1.76（1.57 至 1.97）和 2.44（2.12 至 2.81），与白蛋白/肌酐比值<10mg/g 相比。多变量调整后，男性、黑种人、较大的腰围、糖尿病、心肌梗死或中风病史、他汀类药物的使用以及较低的 eGFR 和较高的白蛋白/肌酐比值与 CKD 患者中的显性治疗抵抗性高血压相关。
结论
本研究强调了显性治疗抵抗性高血压在 CKD 患者中的高患病率。
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