Hermida Ramón C, Ayala Diana E, Mojón Artemio, Fernández José R
Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain
Bioengineering and Chronobiology Laboratories, Atlantic Research Center for Information and Communication Technologies, University of Vigo, Vigo, Spain.
J Am Soc Nephrol. 2017 Sep;28(9):2802-2811. doi: 10.1681/ASN.2016111186. Epub 2017 Apr 28.
The prognostic value of clinic and ambulatory BP in predicting incident CKD and whether CKD risk reduction associates with progressive treatment-induced decrease of clinic, awake, or asleep BP are unknown. We prospectively evaluated 2763 individuals without CKD, 1343 men and 1420 women (mean±SD age: 51.5±14.3 years old), with baseline ambulatory BP ranging from normotension to hypertension. On recruitment and annually thereafter (more frequently if hypertension treatment was adjusted on the basis of ambulatory BP), we simultaneously monitored BP and physical activity (wrist actigraphy) for 48 hours to accurately derive individualized mean awake and asleep BP. During a median 5.9-year follow-up, 404 participants developed CKD. Mean asleep systolic BP was the most significant predictor of CKD in a Cox proportional hazard model adjusted for age, diabetes, serum creatinine concentration, urinary albumin concentration, previous cardiovascular event, and hypertension treatment time (on awakening versus at bedtime; per 1-SD elevation: hazard ratio, 1.44; 95% confidence interval, 1.31 to 1.56; <0.001). The predictive values of mean clinic BP and mean awake or 48-hour ambulatory BP was not significant when corrected by mean asleep BP. Analyses of BP changes during follow-up revealed 27% reduction in the risk of CKD per 1-SD decrease in mean asleep systolic BP, independent of changes in mean clinic BP or awake ambulatory BP. In conclusion, sleep-time BP is a highly significant independent prognostic marker for CKD. Furthermore, progressive treatment-induced decrease of asleep BP, a potential therapeutic target requiring ambulatory BP evaluation, might be a significant method for reducing CKD risk.
临床血压和动态血压在预测新发慢性肾脏病（CKD）方面的预后价值，以及CKD风险降低是否与治疗引起的临床、清醒或睡眠时血压的逐步下降相关，目前尚不清楚。我们对2763名无CKD的个体进行了前瞻性评估，其中男性1343名，女性1420名（平均±标准差年龄：51.5±14.3岁），基线动态血压范围从正常血压到高血压。在招募时以及此后每年（如果根据动态血压调整高血压治疗，则更频繁），我们同时监测血压和身体活动（手腕活动记录仪）48小时，以准确得出个体化的平均清醒和睡眠时血压。在中位5.9年的随访期间，404名参与者发生了CKD。在调整了年龄、糖尿病、血清肌酐浓度、尿白蛋白浓度、既往心血管事件和高血压治疗时间（醒来时与就寝时；每升高1个标准差：风险比，1.44；95%置信区间，1.31至1.56；P<0.001）的Cox比例风险模型中，平均睡眠收缩压是CKD最显著的预测因素。当用平均睡眠血压校正后，平均临床血压以及平均清醒或48小时动态血压的预测价值不显著。随访期间血压变化分析显示，平均睡眠收缩压每降低1个标准差，CKD风险降低27%，与平均临床血压或清醒时动态血压的变化无关。总之，睡眠时间血压是CKD的一个高度显著的独立预后标志物。此外，治疗引起的睡眠时血压逐步下降，这是一个需要动态血压评估的潜在治疗靶点，可能是降低CKD风险的重要方法。
