Jackson Heart Study, Jackson State University.
University of Mississippi Medical Center, Jackson Heart Study, Jackson, Mississippi.
J Hypertens. 2018 Jul;36(7):1524-1532. doi: 10.1097/HJH.0000000000001727.
Hypertension diagnosed by blood pressure (BP) measured in the clinic is associated with rapid kidney function decline (RKFD) and incident chronic kidney disease (CKD). The extent to which hypertension defined using out-of-clinic BP measurements is associated with these outcomes is unclear.
We evaluated the association of any masked hypertension (daytime SBP/DBP ≥ 135/85 mmHg, night-time SBP/DBP ≥ 120/70 mmHg or 24-h SBP/DBP ≥ 130/80 mmHg) with RKFD and incident CKD among 676 African-Americans in the Jackson Heart Study with clinic-measured SBP/DBP less than 140/90 mmHg who completed ambulatory BP monitoring in 2000-2004. RKFD was defined as a decline in estimated glomerular filtration rate (eGFR) at least 30% and incident CKD was defined as development of eGFR less than 60 ml/min per 1.73 m with an at least 25% decline in eGFR between 2000-2004 and 2009-2013.
The mean age of participants was 57.6 years, 28.8% were men and 52.7% had any masked hypertension. After a median follow-up of 8 years, 13.8 and 8.6% of participants had RKFD and incident CKD, respectively. In unadjusted analyses, masked hypertension was associated with an increased odds for incident CKD [odds ratio (OR) 2.20, 95% confidence interval (CI) 1.22, 3.97]. This association remained statistically significant after adjustment for demographic characteristics, baseline eGFR and albumin-to-creatinine ratio (OR 1.95, 95% CI 1.04, 3.67) but was eliminated after propensity score adjustment (OR 1.62, 95% CI 0.87, 3.00). There was no association between masked hypertension and RKFD.
Masked hypertension may be associated with the development of CKD in African-Americans.
在诊所测量血压（BP）诊断出的高血压与肾功能快速下降（RKFD）和慢性肾脏病（CKD）的发生有关。使用诊所外 BP 测量值定义的高血压与这些结果的关联程度尚不清楚。
我们评估了任何隐匿性高血压（白天 SBP/DBP≥135/85mmHg，夜间 SBP/DBP≥120/70mmHg 或 24 小时 SBP/DBP≥130/80mmHg）与在诊所测量的 SBP/DBP 低于 140/90mmHg 的 676 名非裔美国人在 2000-2004 年期间完成动态血压监测的 Jackson 心脏研究中的 RKFD 和新发 CKD 之间的关联。RKFD 的定义为估算肾小球滤过率（eGFR）至少下降 30%，新发 CKD 的定义为 eGFR 下降至低于 60ml/min/1.73m 以下，eGFR 在 2000-2004 年和 2009-2013 年之间至少下降 25%。
参与者的平均年龄为 57.6 岁，28.8%为男性，52.7%患有任何隐匿性高血压。中位随访 8 年后，分别有 13.8%和 8.6%的参与者出现 RKFD 和新发 CKD。在未调整分析中，隐匿性高血压与新发 CKD 的发生几率增加相关[比值比（OR）2.20，95%置信区间（CI）1.22，3.97]。在调整人口统计学特征、基线 eGFR 和白蛋白/肌酐比值后，这种关联仍然具有统计学意义（OR 1.95，95%CI 1.04，3.67），但在倾向评分调整后消除（OR 1.62，95%CI 0.87，3.00）。隐匿性高血压与 RKFD 之间没有关联。
隐匿性高血压可能与非裔美国人 CKD 的发生有关。
