Division of Nephrology, Second University of Naples, Naples, Italy.
Division of Nephrology, Second University of Naples, Naples, Italy.
Am J Kidney Dis. 2016 Jan;67(1):89-97. doi: 10.1053/j.ajkd.2015.08.027. Epub 2015 Oct 23.
Whether blood pressure (BP) plays an independent predictive role in the onset of decreased glomerular filtration rate (GFR) remains ill-defined because existing meta-analyses have incorporated data from studies that included individuals with low GFRs at baseline. This question is critical to optimize chronic kidney disease prevention in the general population.
Systematic review and meta-analysis of longitudinal cohort studies.
SETTING & POPULATION: Adults from general population.
We identified in PubMed, EMBASE, and the Cochrane Library database all cohort studies evaluating the role of BP in the incidence of decreased estimated GFR (eGFR; defined as eGFR<60 mL/min/1.73 m2) in individuals without decreased kidney function at baseline.
Hypertension (BP>140/90 mmHg), prehypertension (systolic BP of 120-139 and/or diastolic BP of 80-89 mmHg), and BP as a continuous variable.
Risk for decreased eGFR reported as relative risk (RR) and 95% CI. Heterogeneity (I2) was also evaluated.
Data from 16 cohorts (315,321 participants) were analyzed. All studies had a Newcastle-Ottawa score in the range of 6 to 8, denoting high quality. During a mean follow-up of 6.5 years, decreased eGFR occurred in 6.6% of participants. The presence of prehypertension and hypertension increased renal risk (RRs of 1.19 [95% CI, 1.07-1.33; I2=23.8%] and 1.76 [95% CI, 1.58-1.97; I2=37.7%], respectively). Similarly, we found that every 10-mm Hg increase in systolic and diastolic BPs associated with higher risk for decreased eGFR (RRs of 1.08 [95% CI, 1.04-1.11; I2=60.0%] and 1.12 [95% CI, 1.04-1.20; I2=51.4%], respectively). Metaregression analysis showed greater risk with older age (P=0.03), whereas other covariates were not significant.
No individual patient-level data.
Prehypertension and hypertension, as BP levels, are independent predictors of decreased GFR in the general population, with the effect being more pronounced in the elderly. These findings are important for improving risk stratification in the general population.
血压（BP）是否在肾小球滤过率（GFR）下降的发生中起独立的预测作用仍不清楚，因为现有的荟萃分析纳入了基线时 GFR 较低的研究数据。这个问题对于优化一般人群的慢性肾脏病预防至关重要。
系统评价和纵向队列研究的荟萃分析。
来自一般人群的成年人。
我们在 PubMed、EMBASE 和 Cochrane 图书馆数据库中检索了所有评估血压在基线时肾功能正常的个体中估计肾小球滤过率（eGFR；定义为 eGFR<60mL/min/1.73m2）下降发生率中的作用的队列研究。
高血压（BP>140/90mmHg）、前期高血压（收缩压 120-139mmHg 和/或舒张压 80-89mmHg）和 BP 作为连续变量。
报告为相对风险（RR）和 95%置信区间的 eGFR 下降风险。还评估了异质性（I2）。
分析了 16 项队列研究（315321 名参与者）的数据。所有研究的 Newcastle-Ottawa 评分均在 6 至 8 分之间，表明质量较高。在平均 6.5 年的随访期间，6.6%的参与者出现 eGFR 下降。前期高血压和高血压的存在增加了肾脏风险（RRs 分别为 1.19（95%CI，1.07-1.33；I2=23.8%）和 1.76（95%CI，1.58-1.97；I2=37.7%））。同样，我们发现收缩压和舒张压每升高 10mmHg，eGFR 下降的风险就会增加（RRs 分别为 1.08（95%CI，1.04-1.11；I2=60.0%）和 1.12（95%CI，1.04-1.20；I2=51.4%））。Meta 回归分析表明，年龄较大时风险更高（P=0.03），而其他协变量则不显著。
没有个体患者水平的数据。
前期高血压和高血压作为血压水平，是一般人群 GFR 下降的独立预测因素，在老年人中作用更为明显。这些发现对于改善一般人群的风险分层很重要。
