老年高血压患者肾功能变化率与死亡率
Rate of change in renal function and mortality in elderly treated hypertensive patients.
作者信息
Chowdhury Enayet K, Langham Robyn G, Ademi Zanfina, Owen Alice, Krum Henry, Wing Lindon M H, Nelson Mark R, Reid Christopher M
机构信息
Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia;
Department of Nephrology and University of Melbourne Department of Medicine, St. Vincent's Hospital, Melbourne, Victoria, Australia;
出版信息
Clin J Am Soc Nephrol. 2015 Jul 7;10(7):1154-61. doi: 10.2215/CJN.07370714. Epub 2015 Apr 21.
BACKGROUND AND OBJECTIVES
Evidence relating the rate of change in renal function, measured as eGFR, after antihypertensive treatment in elderly patients to clinical outcome is sparse. This study characterized the rate of change in eGFR after commencement of antihypertensive treatment in an elderly population, the factors associated with eGFR rate change, and the rate's association with all-cause and cardiovascular mortality.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data from the Second Australian National Blood Pressure study were used, where 6083 hypertensive participants aged ≥65 years were enrolled during 1995-1997 and followed for a median of 4.1 years (in-trial). Following the Second Australian National Blood Pressure study, participants were followed-up for a further median 6.9 years (post-trial). The annual rate of change in the eGFR was calculated in 4940 participants using creatinine measurements during the in-trial period and classified into quintiles (Q) on the basis of the following eGFR changes: rapid decline (Q1), decline (Q2), stable (Q3), increase (Q4), and rapid increase (Q5).
RESULTS
A rapid decline in eGFR in comparison with those with stable eGFRs during the in-trial period was associated with older age, living in a rural area, wider pulse pressure at baseline, receiving diuretic-based therapy, taking multiple antihypertensive drugs, and having blood pressure <140/90 mmHg during the study. However, a rapid increase in eGFR was observed in younger women and those with a higher cholesterol level. After adjustment for baseline and in-trial covariates, Cox-proportional hazard models showed a significantly greater risk for both all-cause (hazard ratio, 1.28; 95% confidence interval, 1.09 to 1.52; P=0.003) and cardiovascular (hazard ratio, 1.40; 95% confidence interval, 1.11 to 1.76; P=0.004) mortality in the rapid decline group compared with the stable group over a median of 7.2 years after the last eGFR measure. No significant association with mortality was observed for a rapid increase in eGFR.
CONCLUSIONS
In elderly persons with treated hypertension, a rapid decline in eGFR is associated with a higher risk of mortality.
背景与目的
关于老年患者接受抗高血压治疗后，以估算肾小球滤过率（eGFR）衡量的肾功能变化率与临床结局之间关系的证据较少。本研究描述了老年人群开始抗高血压治疗后eGFR的变化率、与eGFR变化率相关的因素，以及该变化率与全因死亡率和心血管死亡率的关联。
设计、研究地点、参与者及测量指标：使用了澳大利亚第二次全国血压研究的数据，该研究在1995 - 1997年纳入了6083名年龄≥65岁的高血压参与者，并进行了中位时间为4.1年的随访（试验期间）。在澳大利亚第二次全国血压研究之后，参与者又进行了中位时间为6.9年的随访（试验后）。使用试验期间的肌酐测量值计算了4940名参与者的eGFR年变化率，并根据以下eGFR变化分为五分位数（Q）：快速下降（Q1）、下降（Q2）、稳定（Q3）、上升（Q4）和快速上升（Q5）。
结果
与试验期间eGFR稳定的参与者相比，eGFR快速下降与年龄较大、居住在农村地区、基线时脉压较宽、接受基于利尿剂的治疗、服用多种抗高血压药物以及研究期间血压<140/90 mmHg有关。然而，在年轻女性和胆固醇水平较高的人群中观察到eGFR快速上升。在对基线和试验期间协变量进行调整后，Cox比例风险模型显示，在最后一次eGFR测量后的中位7.2年期间，与稳定组相比，快速下降组的全因死亡风险（风险比，1.28；95%置信区间，1.09至1.52；P = 0.003）和心血管死亡风险（风险比，1.40；95%置信区间，1.11至1.76；P = 0.004）显著更高。未观察到eGFR快速上升与死亡率之间存在显著关联。
结论
在接受治疗的老年高血压患者中，eGFR快速下降与较高的死亡风险相关。
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