Sethna Christine B, Meyers Kevin E C, Mariani Laura H, Psoter Kevin J, Gadegbeku Crystal A, Gibson Keisha L, Srivastava Tarak, Kretzler Matthias, Brady Tammy M
From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.).
Hypertension. 2017 Aug;70(2):315-323. doi: 10.1161/HYPERTENSIONAHA.117.09475. Epub 2017 Jun 26.
Hypertension and blood pressure variability (BPV; SD and average real variability) in primary proteinuric glomerulopathies are not well described. Data were from 433 participants in the NEPTUNE (Nephrotic Syndrome Study Network). Hypertensive BP status was defined as previous history of hypertension or BP ≥140/90 mm Hg for adults/≥95th percentile for children at baseline. BPV was measured in participants with ≥3 visits in the first year. Two-hundred ninety-six adults (43 years [interquartile range, 32-57.8 years], 61.5% male) and 147 children (11 years [interquartile range, 5-14 years], 57.8% male) were evaluated. At baseline, 64.8% of adults and 46.9% of children were hypertensive. Histological diagnosis was associated with hypertensive status in adults (=0.036). In adults, hypertensive status was associated with lower hazard of complete remission (hazard ratio, 0.36; 95% confidence interval, 0.19-0.68) and greater hazard of achieving the composite end point (end-stage renal disease or estimated glomerular filtration rate decline >40%; hazard ratio, 4.1; 95% confidence interval, 1.4-12). Greater systolic and diastolic SD and average real variability were also associated with greater hazard of reaching the composite end point in adults (all <0.01). In children, greater BPV was an independent predictor of composite end point (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability; all <0.05). Hypertensive status was common among adults and children enrolled in NEPTUNE. Differences in hypertensive status prevalence, BPV, and treatment were found by age and histological diagnosis. In addition, hypertensive status and greater BPV were associated with poorer clinical outcomes.
原发性蛋白尿性肾小球病中的高血压和血压变异性（BPV；标准差和平均实际变异性）尚未得到充分描述。数据来自肾病综合征研究网络（NEPTUNE）的433名参与者。高血压血压状态定义为既往有高血压病史或基线时成人血压≥140/90 mmHg/儿童血压≥第95百分位数。在第一年有≥3次就诊的参与者中测量BPV。对296名成年人（43岁[四分位间距，32 - 57.8岁]，61.5%为男性）和147名儿童（11岁[四分位间距，5 - 14岁]，57.8%为男性）进行了评估。基线时，64.8%的成年人和46.9%的儿童患有高血压。组织学诊断与成年人的高血压状态相关（=0.036）。在成年人中，高血压状态与完全缓解的较低风险相关（风险比，0.36；95%置信区间，0.19 - 0.68）以及达到复合终点（终末期肾病或估计肾小球滤过率下降>40%）的较高风险相关（风险比，4.1；95%置信区间，1.4 - 12）。更大的收缩压和舒张压标准差以及平均实际变异性也与成年人达到复合终点的较高风险相关（均<0.01）。在儿童中，更大的BPV是复合终点（由收缩压标准差和平均实际变异性决定）和完全缓解（由收缩压和舒张压平均实际变异性决定；均<0.05）的独立预测因素。高血压状态在参与NEPTUNE的成年人和儿童中很常见。按年龄和组织学诊断发现高血压状态患病率、BPV和治疗存在差异。此外，高血压状态和更大的BPV与较差的临床结局相关。
