Department of Family Medicine, Clalit Health Services, Jerusalem, Israel.
Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel.
Am J Med. 2017 Nov;130(11):1324.e7-1324.e13. doi: 10.1016/j.amjmed.2017.05.030. Epub 2017 Jun 13.
Recently, the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive lowering of systolic blood pressure is beneficial, but is associated with more adverse events. Hyponatremia was notably more frequent in the intensive treatment group. Investigating its risk factors is crucial for preventing this complication. Our objective in this study was to identify risk factors for hyponatremia in the adult population.
We investigated the baseline demographic, clinical, and laboratory data from the 9361 participants of SPRINT to identify the best predictors of hyponatremia (serum sodium ≤130 mEq/L), and adverse events, which could be attributed to hyponatremia, using machine learning and multivariable Cox proportional hazards models. We confirmed our results in the independent National Health and Nutrition Examination Survey (NHANES) cohort between the years 2005 and 2010 (16,501 participants).
Elevated baseline high-density lipoprotein cholesterol (HDL-C) was a strong predictor of future hyponatremia. Multivariable Cox regression showed hyponatremia events to be significantly increased for SPRINT participants with baseline HDL-C levels in the highest quintile (hazard ratio [HR] 2.8; 95% confidence interval [CI], 2.2-3.7; P <.001), and were also associated with treatment-related serious adverse events (HR 1.6; 95% CI, 1.3-2.1; P <.001). We confirmed the association between HDL-C and hyponatremia in the NHANES cohort (HR 2.5; 95% CI, 1.7-3.7; P <.001).
Elevated HDL-C (≥62 mg/dL) is a risk factor for hyponatremia. Thus, hypertensive patients with elevated HDL-C should be closely monitored for hyponatremia when treated for hypertension.
最近，收缩压干预试验（SPRINT）表明，强化降低收缩压是有益的，但与更多的不良事件相关。在强化治疗组中，低钠血症更为常见。研究其危险因素对于预防这种并发症至关重要。我们在这项研究中的目的是确定 SPRINT 中成年人群低钠血症的危险因素。
我们研究了 SPRINT 中的 9361 名参与者的基线人口统计学、临床和实验室数据，以使用机器学习和多变量 Cox 比例风险模型确定低钠血症（血清钠≤130mEq/L）和可归因于低钠血症的不良事件的最佳预测因素。我们在 2005 年至 2010 年之间的独立国家健康和营养检查调查（NHANES）队列中证实了我们的结果（16501 名参与者）。
基线高密度脂蛋白胆固醇（HDL-C）升高是未来低钠血症的强烈预测因素。多变量 Cox 回归显示，SPRINT 参与者的低钠血症事件明显增加，其基线 HDL-C 水平处于最高五分位（危险比[HR]2.8；95%置信区间[CI]2.2-3.7；P<.001），并且与治疗相关的严重不良事件也相关（HR 1.6；95%CI，1.3-2.1；P<.001）。我们在 NHANES 队列中证实了 HDL-C 与低钠血症之间的关联（HR 2.5；95%CI，1.7-3.7；P<.001）。
HDL-C（≥62mg/dL）升高是低钠血症的危险因素。因此，高血压患者在治疗高血压时，如果 HDL-C 升高，应密切监测低钠血症。
