日本普通人群中的长期血压变异性、新发糖尿病和新发慢性肾脏病
Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population.
作者信息
Yano Yuichiro, Fujimoto Shouichi, Kramer Holly, Sato Yuji, Konta Tsuneo, Iseki Kunitoshi, Iseki Chiho, Moriyama Toshiki, Yamagata Kunihiro, Tsuruya Kazuhiko, Narita Ichiei, Kondo Masahide, Kimura Kenjiro, Asahi Koichi, Kurahashi Issei, Ohashi Yasuo, Watanabe Tsuyoshi
机构信息
From the Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (Y.Y.); Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine (S.F.) and Dialysis Division, University of Miyazaki Hospital (Y.S.), University of Miyazaki, Miyazaki, Japan; Department of Public Health Sciences (H.K.) and Division of Nephrology and Hypertension (H.K.), Loyola Medical Center, Maywood, IL; Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan (T.K.); Dialysis Unit, University Hospital of the Ryukyus, Okinawa, Japan (K.I., C.I.); Health Care Center, Osaka University, Osaka, Japan (T.M.); Department of Nephrology (K.Y.) and Department of Health Care Policy and Health Economics (M.K.), Faculty of Medicine, University of Tsukuba, Ibarak, Japan; Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan (K.T.); Division of Clinical Nephrology and Rheumatology, Niigata University Medical School, Nigata, Japan (I.N.); Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan (K.K.); Department of Nephrology, Hypertension, Diabetology, Endocrinology and Metabolism, School of Medicine, Fukushima Medical University, Fukushima, Japan (K.A., T.W.); iAnalysis LLC, Tokyo, Japan (K.I); and Department of Integrated Science and Engineering for Sustainable Society, Chuo University, Tokyo, Japan (Y.O.).
出版信息
Hypertension. 2015 Jul;66(1):30-6. doi: 10.1161/HYPERTENSIONAHA.115.05472. Epub 2015 May 18.
Whether long-term blood pressure (BP) variability among individuals without diabetes mellitus is associated with new-onset chronic kidney disease (CKD) risk, independently of other BP parameters (eg, mean BP, cumulative exposure to BP) and metabolic profile changes during follow-up, remains uncertain. We used data from a nationwide study of 48 587 Japanese adults aged 40 to 74 years (mean age, 61.7 years; 39% men) without diabetes mellitus or CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2 or proteinuria by dipstick). BP was measured at baseline and during 3 annual follow-up visits (4 visits). BP variability was defined as standard deviation (SD) and average real variability during the 4 visits. At the year 3 follow-up visit, 6.3% of the population had developed CKD. In multivariable-adjusted logistic regression models, 1 SD increases in SDSBP (per 5 mmHg), SDDBP (per 3 mmHg), average real variabilitySBP (per 6 mmHg), and average real variabilityDBP (per 4 mmHg) were associated with new-onset CKD (odds ratios [ORs] and 95% confidence intervals, 1.15 [1.11-1.20], 1.08 [1.04-1.12], 1.13 [1.09-1.17], 1.06 [1.02-1.10], respectively; all P<0.01) after adjustment for clinical characteristics, and with mean BP from year 0 to year 3. The associations of SDBP and average real variabilityBP with CKD remained significant after additional adjustments for metabolic parameter changes during follow-up (ORs, 1.06-1.15; all P<0.01). Sensitivity analyses by sex, antihypertensive medication use, and the presence of hypertension showed similar conclusions. Among those in the middle-aged and elderly general population without diabetes mellitus, long-term BP variability during 3 years was associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up.
在无糖尿病的个体中，长期血压（BP）变异性是否与新发慢性肾脏病（CKD）风险相关，独立于其他血压参数（如平均血压、血压累积暴露量）以及随访期间的代谢谱变化，目前仍不确定。我们使用了一项针对48587名40至74岁日本成年人（平均年龄61.7岁；39%为男性）的全国性研究数据，这些人无糖尿病或CKD（估计肾小球滤过率<60 mL/min/1.73 m²或尿试纸检测有蛋白尿）。在基线及3次年度随访（共4次就诊）期间测量血压。血压变异性定义为4次就诊期间的标准差（SD）和平均实际变异性。在第3年随访时，6.3%的人群发生了CKD。在多变量调整的逻辑回归模型中，收缩压标准差（SDSBP，每5 mmHg增加1 SD）、舒张压标准差（SDDBP，每3 mmHg增加1 SD）、收缩压平均实际变异性（每6 mmHg增加1 SD）和舒张压平均实际变异性（每4 mmHg增加1 SD）在调整临床特征以及0年至3年的平均血压后，均与新发CKD相关（比值比[ORs]及95%置信区间分别为1.15[1.11 - 1.20]、1.08[1.04 - 1.12]、1.13[1.09 - 1.17]、1.06[1.02 - 1.10]；均P<0.01）。在对随访期间代谢参数变化进行额外调整后，舒张压标准差和血压平均实际变异性与CKD的关联仍然显著（ORs为1.06 - 1.15；均P<0.01）。按性别、使用抗高血压药物情况以及是否存在高血压进行的敏感性分析得出了类似结论。在无糖尿病的中老年普通人群中，3年期间的长期血压变异性与新发CKD风险相关，独立于平均血压或血压累积暴露量以及随访期间的代谢谱变化。
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