Cheung Alfred K, Rahman Mahboob, Reboussin David M, Craven Timothy E, Greene Tom, Kimmel Paul L, Cushman William C, Hawfield Amret T, Johnson Karen C, Lewis Cora E, Oparil Suzanne, Rocco Michael V, Sink Kaycee M, Whelton Paul K, Wright Jackson T, Basile Jan, Beddhu Srinivasan, Bhatt Udayan, Chang Tara I, Chertow Glenn M, Chonchol Michel, Freedman Barry I, Haley William, Ix Joachim H, Katz Lois A, Killeen Anthony A, Papademetriou Vasilios, Ricardo Ana C, Servilla Karen, Wall Barry, Wolfgram Dawn, Yee Jerry
Division of Nephrology and Hypertension and
Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah.
J Am Soc Nephrol. 2017 Sep;28(9):2812-2823. doi: 10.1681/ASN.2017020148. Epub 2017 Jun 22.
The appropriate target for BP in patients with CKD and hypertension remains uncertain. We report prespecified subgroup analyses of outcomes in participants with baseline CKD in the Systolic Blood Pressure Intervention Trial. We randomly assigned participants to a systolic BP target of <120 mm Hg (intensive group; =1330) or <140 mm Hg (standard group; =1316). After a median follow-up of 3.3 years, the primary composite cardiovascular outcome occurred in 112 intensive group and 131 standard group CKD participants (hazard ratio [HR], 0.81; 95% confidence interval [95% CI], 0.63 to 1.05). The intensive group also had a lower rate of all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99). Treatment effects did not differ between participants with and without CKD ( values for interactions ≥0.30). The prespecified main kidney outcome, defined as the composite of ≥50% decrease in eGFR from baseline or ESRD, occurred in 15 intensive group and 16 standard group participants (HR, 0.90; 95% CI, 0.44 to 1.83). After the initial 6 months, the intensive group had a slightly higher rate of change in eGFR (-0.47 versus -0.32 ml/min per 1.73 m per year; <0.03). The overall rate of serious adverse events did not differ between treatment groups, although some specific adverse events occurred more often in the intensive group. Thus, among patients with CKD and hypertension without diabetes, targeting an SBP<120 mm Hg compared with <140 mm Hg reduced rates of major cardiovascular events and all-cause death without evidence of effect modifications by CKD or deleterious effect on the main kidney outcome.
慢性肾脏病（CKD）合并高血压患者的血压合适目标仍不明确。我们报告了收缩压干预试验中具有基线CKD参与者结局的预先设定亚组分析。我们将参与者随机分配至收缩压目标<120 mmHg（强化组；n = 1330）或<140 mmHg（标准组；n = 1316）。中位随访3.3年后，112名强化组和131名标准组CKD参与者发生了主要复合心血管结局（风险比[HR]，0.81；95%置信区间[95%CI]，0.63至1.05）。强化组的全因死亡率也较低（HR，0.72；95%CI，0.53至0.99）。有或无CKD的参与者之间治疗效果无差异（交互作用P值≥0.30）。预先设定的主要肾脏结局定义为估算肾小球滤过率（eGFR）自基线下降≥50%或终末期肾病（ESRD）的复合情况，15名强化组和16名标准组参与者出现该结局（HR，0.90；95%CI，0.44至1.83）。在最初6个月后，强化组的eGFR变化率略高（-0.47对比-0.32 ml/min/1.73 m²/年；P<0.03）。尽管一些特定不良事件在强化组中更常发生，但治疗组之间严重不良事件的总体发生率无差异。因此，在无糖尿病的CKD合并高血压患者中，将收缩压目标设定为<120 mmHg对比<140 mmHg可降低主要心血管事件和全因死亡率，且没有证据表明CKD会改变治疗效果或对主要肾脏结局产生有害影响。
