Franco Palacios Carlos R, Goyal Pankaj, Thompson Amanda M, Deschaine Brent
Nephrology Department, Affiliated Community Medical Centers, Rice Memorial Hospital, 101 Willmar 274 Ave SW., Willmar, MN 56201 USA.
Hospital Medicine Department, Affiliated Community Medical Centers. Rice Memorial Hospital, Willmar, MN USA.
Clin Hypertens. 2016 Nov 23;22:21. doi: 10.1186/s40885-016-0056-7. eCollection 2016.
LVH is highly prevalent in patients with CKD and is independently associated with subsequent cardiovascular events. We hypothesized that adding systolic blood pressure values to LVH might differentiate different subgroups of patients at higher risk of cardiovascular events (CVE) and other adverse outcomes.
Retrospective cohort study of 243 patients older than 60 years with stages 1-5 pre-dialysis CKD. LVH was assessed by electrocardiogram or echocardiogram.
Cardiovascular events occurred in 7 patients (10.3%) among those with SBP <130 and no LVH, 8 patients (10.5%) among those with SBP ≥130 and no LVH, 7 patients (21.2%) among those with SBP <130 and LVH and 25 patients (37.9%) among those with SBP ≥ 130 and LVH. On multivariate analyses, comparing to SBP < 130 and no LVH, the HR for CVE in those with SBP ≥ 130 and LVH was 4 (1.75, 10.3), = 0.0007; 2.13 (0.71, 6.32) = 0.16 in those with SBP <130 and LVH and 1.20 (0.42, 3.51) = 0.72 in those with SBP ≥130 and no LVH. No significant differences were noted in changes in renal function and mortality rates among the groups.
The combination of higher systolic blood pressure and LVH might identify older patients with CKD at higher risk of cardiovascular outcomes.
左心室肥厚（LVH）在慢性肾脏病（CKD）患者中非常普遍，并且与随后的心血管事件独立相关。我们假设将收缩压值与LVH相结合可能会区分出心血管事件（CVE）和其他不良结局风险较高的不同亚组患者。
对243例年龄大于60岁的1-5期透析前CKD患者进行回顾性队列研究。通过心电图或超声心动图评估LVH。
收缩压<130且无LVH的患者中有7例（10.3%）发生心血管事件，收缩压≥130且无LVH的患者中有8例（10.5%）发生心血管事件，收缩压<130且有LVH的患者中有7例（21.2%）发生心血管事件，收缩压≥130且有LVH的患者中有25例（37.9%）发生心血管事件。多因素分析显示，与收缩压<130且无LVH的患者相比，收缩压≥130且有LVH的患者发生CVE的风险比为4（1.75，10.3），P = 0.0007；收缩压<130且有LVH的患者为2.13（0.71，6.32），P = 0.16；收缩压≥130且无LVH的患者为1.20（0.42，3.51），P = 0.72。各组间肾功能变化和死亡率无显著差异。
较高的收缩压与LVH相结合可能会识别出心血管结局风险较高的老年CKD患者。
