Himeno Taroh, Okuno Tazuo, Watanabe Keisuke, Nakajima Kumie, Iritani Osamu, Yano Hiroshi, Morita Takuro, Igarashi Yuta, Okuro Masashi, Morimoto Shigeto
Department of Geriatric Medicine, Kanazawa Medical University, Ishikawa, Japan.
J Int Med Res. 2018 Jan;46(1):293-306. doi: 10.1177/0300060517721795. Epub 2017 Aug 23.
Objective Low systolic blood pressure (SBP) is associated with an increased risk for cardiovascular morbidity/mortality in older patients with chronic kidney disease (CKD). The present study evaluated the association between range in blood pressure and first care-needs certification in the Long-term Care Insurance (LTCI) system or death in community-dwelling older subjects with or without CKD. Methods CKD was defined as an estimated glomerular filtration rate <60 ml/min/1.73 m or dipstick proteinuria of + or greater. Our study was conducted in 1078 older subjects aged 65-94 years. Associations were estimated using the Cox proportional hazards model. Results During 5 years of follow-up, 135 first certifications and 53 deaths occurred. Among patients with CKD, moderate SBP (130-159 mmHg) was associated with a significantly lower adjusted risk of subsequent total certification (hazard ratio [HR] = 0.44) and subsequent certification owing to dementia (HR = 0.17) compared with SBP < 130 mmHg. These relationships were not observed in non-CKD subjects. Conclusion Lower SBP of <130 mmHg may predict a higher risk for subsequent first care-needs certification in LTCI, especially for dementia, in community-dwelling patients with CKD.
目的 收缩压（SBP）降低与老年慢性肾脏病（CKD）患者心血管疾病发病率/死亡率增加相关。本研究评估了血压范围与长期护理保险（LTCI）系统中的首次护理需求认证或社区居住的老年CKD患者或非CKD患者死亡之间的关联。方法 CKD定义为估算肾小球滤过率<60 ml/min/1.73 m²或尿试纸蛋白尿为+或更高。我们的研究在1078名65-94岁的老年受试者中进行。使用Cox比例风险模型估计关联。结果 在5年的随访期间，发生了135次首次认证和53例死亡。在CKD患者中，与SBP<130 mmHg相比，中度SBP（130-159 mmHg）与随后的总认证调整风险（风险比[HR]=0.44）和因痴呆导致的随后认证风险（HR=0.17）显著降低相关。在非CKD受试者中未观察到这些关系。结论 <130 mmHg的较低SBP可能预示社区居住的CKD患者在LTCI中随后首次护理需求认证的风险较高，尤其是痴呆方面。
