American Society of Hypertension Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine, Chicago, IL 60637, USA.
Am J Nephrol. 2013;38(3):195-203. doi: 10.1159/000354232. Epub 2013 Aug 21.
Among elderly hypertensive patients, we aimed to assess the association of nocturnal blood pressure (BP) pattern on stroke; interaction of dipping pattern with kidney disease was explored.
We retrospectively analyzed the records of 1,276 elderly (≥60 years) hypertensive Japanese patients (mean 74 years; 40% were men) who had measurements of estimated glomerular filtration rate and ambulatory BP.
Stroke events occurred in 73 people over an average of 3.2 years (4,026 person-years). Chronic kidney disease (CKD) at baseline (n = 634, 50%) was more prevalent in people with strokes (71%) than those without strokes (48%; p < 0.01). Both CKD and nocturnal systolic BP (SBP) increase (10 mm Hg) were independently associated with increased risk for stroke [hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.1-3.1 for CKD and HR 1.2; 1.1-1.4 for SBP]. After adjustment for office SBP, a 10-mm Hg increase in nocturnal SBP was similarly associated with strokes in patients with CKD (HR 1.2; 95% CI 1.0-1.3) and those without CKD (HR 1.2; 95% CI 0.97-1.5). Although reverse dipping (nocturnal SBP ≥ daytime SBP) was associated with stroke only in patients with CKD (HR 2.1; 95% CI 1.1-4.1) and not those without CKD (HR 1.1; 95% CI 0.3-3.8), the interaction effect was not significant (p = 0.30).
In elderly hypertensive patients, both high nocturnal SBP and CKD are independent risk factors for stroke.
在老年高血压患者中，我们旨在评估夜间血压（BP）模式与中风的关系；并探讨这种模式与肾脏疾病之间的相互作用。
我们回顾性分析了 1276 名老年（≥60 岁）日本高血压患者（平均年龄 74 岁；40%为男性）的记录，这些患者有估算肾小球滤过率和动态血压测量值。
在平均 3.2 年（4026 人年）的时间里，73 人发生了中风事件。基线时患有慢性肾脏病（CKD）（n = 634，50%）的患者发生中风的比例（71%）高于无中风患者（48%；p < 0.01）。CKD 和夜间收缩压（SBP）升高（10mmHg）均与中风风险增加独立相关[风险比（HR），1.9；95%置信区间（CI），1.1-3.1 为 CKD，HR 1.2；1.1-1.4 为 SBP]。在校正诊室 SBP 后，CKD 患者夜间 SBP 升高 10mmHg 与中风的相关性相似（HR 1.2；95% CI 1.0-1.3）和无 CKD 患者（HR 1.2；95% CI 0.97-1.5）。尽管夜间 SBP 反杓型（夜间 SBP≥日间 SBP）仅与 CKD 患者（HR 2.1；95% CI 1.1-4.1）而不是无 CKD 患者（HR 1.1；95% CI 0.3-3.8）中风相关，但交互作用不显著（p = 0.30）。
在老年高血压患者中，夜间 SBP 升高和 CKD 均是中风的独立危险因素。
