Nuffield Department of Medicine, University of Oxford, Oxford, UK Department of Geratology, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
BMJ Open. 2016 Jun 10;6(6):e010702. doi: 10.1136/bmjopen-2015-010702.
To determine the relationship between renal function and visit-to-visit blood pressure (BP) variability in a cohort of primary care patients.
Retrospective cohort study from routinely collected healthcare data.
Primary care in Nijmegen, the Netherlands, from 2007 to 2012.
19 175 patients who had a measure of renal function, and 7 separate visits with BP readings in the primary care record.
Visit-to-visit variability in systolic BP, calculated from the first 7 office measurements, including SD, successive variation, absolute real variation and metrics of variability shown to be independent of mean. Multiple linear regression was used to analyse the influence of estimated glomerular filtration rate (eGFR) on BP variability measures with adjustment for age, sex, diabetes, mean BP, proteinuria, cardiovascular disease, time interval between measures and antihypertensive use.
In the patient cohort, 57% were women, mean (SD) age was 65.5 (12.3) years, mean (SD) eGFR was 75.6 (18.0) mL/min/1.73m(2) and SD systolic BP 148.3 (21.4) mm Hg. All BP variability measures were negatively correlated with eGFR and positively correlated with age. However, multiple linear regressions demonstrated consistent, small magnitude negative relationships between eGFR and all measures of BP variability adjusting for confounding variables.
Worsening renal function is associated with small increases in measures of visit-to-visit BP variability after adjustment for confounding factors. This is seen across the spectrum of renal function in the population, and provides a mechanism whereby chronic kidney disease may raise the risk of cardiovascular events.
在初级保健患者队列中确定肾功能与随访间血压（BP）变异性之间的关系。
回顾性队列研究，使用常规收集的医疗保健数据。
荷兰奈梅亨的初级保健。
19175 名患者，他们的肾功能指标和 7 次在初级保健记录中的 BP 读数。
使用前 7 次办公室测量值计算收缩压的随访间变异性，包括标准差、连续变化、绝对真实变化以及与平均值无关的变异性指标。使用多元线性回归分析估计肾小球滤过率（eGFR）对 BP 变异性指标的影响，调整年龄、性别、糖尿病、平均 BP、蛋白尿、心血管疾病、测量间隔和降压药使用。
在患者队列中，57%为女性，平均（SD）年龄为 65.5（12.3）岁，平均（SD）eGFR 为 75.6（18.0）mL/min/1.73m²，收缩压标准差为 148.3（21.4）mmHg。所有 BP 变异性指标均与 eGFR 呈负相关，与年龄呈正相关。然而，多元线性回归显示，在调整混杂因素后，eGFR 与所有 BP 变异性指标之间存在一致的、较小幅度的负相关关系。
在调整混杂因素后，肾功能恶化与随访间 BP 变异性指标的小幅度增加相关。这在人群肾功能谱中都可见到，为慢性肾病可能增加心血管事件风险提供了一种机制。
