Jeffers Barrett W, Zhou Duo
Kidney Blood Press Res. 2017;42(4):697-707. doi: 10.1159/000484103. Epub 2017 Oct 18.
BACKGROUND/AIMS: To investigate the impact of kidney function (using estimated glomerular filtration rate, [eGFR]) on blood pressure variability (BPV) via a retrospective post hoc analysis of patients with hypertension enrolled in two large clinical trials.
Subject-level data were extracted from ASCOT (N=18,852) and ALLHAT (N=26,441) databases; both were randomized, active controlled studies, with treatment duration for hypertension ≥4 years. Visit-to-visit BPV was assessed using the square root of the coefficient of variation of systolic blood pressure (SBP) across visits from 12 weeks onwards. Baseline GFR, estimated by the simplified Modification of Diet in Renal Disease equation, was stratified into ≤60, 61-90, and >90 mL/min/1.73 m2. The relationship between baseline eGFR and systolic BPV was analyzed using an analysis of covariance, with baseline factors considered as covariates. Studies were pooled and analyzed individually.
Patient characteristics were largely consistent between studies. In the pooled population (n=38,133) there were 19.1%, 62.9%, and 18.0% patients, with eGFR ≤60, 61-90, and > 90 mL/min/1.73 m2, respectively. Patients with lower baseline eGFR had higher systolic BPV, in the pooled population and the individual analyses. Other baseline predictors of high systolic BPV included high SBP and age, being male, and a smoker. An amlodipine-based regimen was a negative predictor of high systolic BPV, vs. other antihypertensives, regardless of eGFR.
Patients with declining renal function tended to have higher systolic BPV vs. those without, even after adjusting for risk factors. Amlodipine-based therapy reduced BPV more than other antihypertensive agents, regardless of level of eGFR.
背景/目的：通过对两项大型临床试验中纳入的高血压患者进行回顾性事后分析，研究肾功能（采用估计肾小球滤过率，[eGFR]）对血压变异性（BPV）的影响。
从ASCOT（N = 18,852）和ALLHAT（N = 26,441）数据库中提取个体水平的数据；这两项均为随机、活性对照研究，高血压治疗持续时间≥4年。从第12周起，使用各次就诊时收缩压（SBP）变异系数的平方根评估就诊间BPV。通过简化的肾脏疾病饮食改良方程估算的基线GFR被分层为≤60、61 - 90和>90 mL/min/1.73 m²。使用协方差分析来分析基线eGFR与收缩压BPV之间的关系，将基线因素视为协变量。对研究进行合并并单独分析。
两项研究中的患者特征基本一致。在合并人群（n = 38,133）中，eGFR≤60、61 - 90和>90 mL/min/1.73 m²的患者分别占19.1%、62.9%和18.0%。在合并人群和个体分析中，基线eGFR较低的患者收缩压BPV较高。收缩压BPV高的其他基线预测因素包括高SBP、年龄、男性和吸烟者。与其他抗高血压药物相比，无论eGFR如何，基于氨氯地平的治疗方案是收缩压BPV高的负性预测因素。
即使在调整风险因素后，肾功能下降的患者与肾功能正常的患者相比，收缩压BPV往往更高。无论eGFR水平如何，基于氨氯地平的治疗比其他抗高血压药物更能降低BPV。
