Department of Internal Medicine, Einstein Medical Center, USA.
Heart and Vascular Institute, Division of Cardiology, Einstein Medical Center, USA.
Am J Hypertens. 2017 Dec 8;31(1):48-52. doi: 10.1093/ajh/hpx128.
Visit-to-visit blood pressure variability has been associated with adverse cardiovascular outcomes. Using the SPRINT trial data set, we explored the relationship between blood pressure variability, cardiovascular outcomes, and hypoperfusion-related adverse events of antihypertensive therapy in patients with chronic kidney disease (CKD) enrolled in the study.
The analyses included patients with CKD randomized in SPRINT who reached the target systolic blood pressure for their respective groups (intensive <120 mm Hg; standard <140 mm Hg). Coefficients of variation (CV) for diastolic blood pressure (DBP) for each subject characterized variability. Cox proportional hazards regression was used to identify independent predictors of the SPRINT primary outcome (including acute coronary syndrome, stroke, acute heart failure, and death from cardiovascular causes) and the 3 major side effects of therapy-hypotension, syncope, and acute kidney injury (AKI). P <0.15 on univariate analysis was required to enter the model, and P <0.05 to remain in it.
Overall, 2,488 subjects (1,273 standard; 1,124 intensive) met inclusion criteria. DBP CV predicted a greater hazard for primary outcome (hazard ratio [HR] 1.126, P < 0.0001) in the overall model as well as in separate analyses by treatment arms (standard group HR 1.107, P < 0.0001; intensive group HR 1.100, P = 0.0004). DBP CV also independently predicted a greater hazard for AKI (HR 1.117), syncope (HR 1.111), and hypotensive events (HR 1.104).
Visit-to-visit DBP variability independently predicts worse cardiovascular outcomes and hypoperfusion-related adverse events in patients with CKD enrolled in SPRINT.
血压变异性与不良心血管结局相关。使用 SPRINT 试验数据集，我们探讨了在该研究中纳入的慢性肾脏病（CKD）患者中，血压变异性、心血管结局和降压治疗与灌注不足相关不良事件之间的关系。
分析包括在 SPRINT 中随机分配至目标收缩压组的 CKD 患者（强化组<120mmHg；标准组<140mmHg）。每位患者的舒张压（DBP）变异系数（CV）用于描述变异性。Cox 比例风险回归用于确定 SPRINT 主要结局（包括急性冠状动脉综合征、中风、急性心力衰竭和心血管原因导致的死亡）和治疗的 3 大副作用（低血压、晕厥和急性肾损伤（AKI））的独立预测因素。单因素分析 P<0.15 者需要进入模型，P<0.05 者需要保留在模型中。
总体而言，2488 例患者（标准组 1273 例，强化组 1124 例）符合纳入标准。DBP CV 预测主要结局的风险更高（风险比[HR]1.126，P<0.0001），在整个模型以及按治疗臂的单独分析中均如此（标准组 HR 1.107，P<0.0001；强化组 HR 1.100，P=0.0004）。DBP CV 还独立预测 AKI（HR 1.117）、晕厥（HR 1.111）和低血压事件（HR 1.104）的风险更高。
在 SPRINT 中纳入的 CKD 患者中，DBP 变异性独立预测更差的心血管结局和与灌注不足相关的不良事件。
