Viazzi Francesca, Greco Eulalia, Ceriello Antonio, Fioretto Paola, Giorda Carlo, Guida Pietro, Russo Giuseppina, De Cosmo Salvatore, Pontremoli Roberto
Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.
Department of Medical Sciences, Scientific Institute "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy.
Kidney Blood Press Res. 2018;43(2):422-438. doi: 10.1159/000488255. Epub 2018 Mar 16.
BACKGROUND/AIMS: Apparent treatment resistant hypertension (aTRH) is highly prevalent in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD). The impact of aTRH and achievement of recommended blood pressure (BP) values on the rate of glomerular filtration rate (eGFR) loss in CKD patients is poorly known. To assess the role of aTRH and time-updated BP control (BPC) on the progression of CKD in patients with T2D and hypertension (HT) in real life clinical practice.
Clinical records from a total of 2,778 diabetic patients with HT and stage 3 CKD (i.e. baseline eGFR values between 30 and 60 ml/min) and regular visits during a four-year follow-up were analyzed. The association between BPC (i.e. 75% of visits with BP <140/90 mmHg) and eGFR loss (i.e. a >30% reduction from baseline) or worsening of albuminuria status over time was assessed.
At baseline 33% of patients had aTRH. Over the 4-year follow-up, 20% had a >30% eGFR reduction. Patients with aTRH had an increased risk of eGFR loss >30% (OR 1.31; P<0.007). In patients with aTRH, BPC was associated with a 79% (P=0.029) greater risk of eGFR reduction despite a 58% (P=0.001) lower risk of albuminuria status worsening. In non-aTRH, no association was found between BPC and renal outcome.
In patients with stage 3 CKD the presence of aTRH entails a faster loss of eGFR. More effective prevention of aTRH should be implemented as this condition is associated with a burden of risk not modifiable by tight BP reduction.
背景/目的：在2型糖尿病（T2D）和慢性肾脏病（CKD）患者中，明显治疗抵抗性高血压（aTRH）非常普遍。aTRH以及达到推荐血压（BP）值对CKD患者肾小球滤过率（eGFR）下降速率的影响尚不清楚。旨在评估在现实临床实践中，aTRH和动态血压控制（BPC）对T2D和高血压（HT）患者CKD进展的作用。
分析了总共2778例患有HT和3期CKD（即基线eGFR值在30至60 ml/min之间）的糖尿病患者的临床记录以及四年随访期间的定期就诊情况。评估了BPC（即75%的就诊时BP<140/90 mmHg）与eGFR下降（即较基线降低>30%）或随时间蛋白尿状态恶化之间的关联。
基线时33%的患者患有aTRH。在4年随访期间，20%的患者eGFR下降>30%。患有aTRH的患者eGFR下降>30%的风险增加（OR 1.31；P<0.007）。在患有aTRH的患者中，尽管蛋白尿状态恶化的风险降低了58%（P=0.001），但BPC与eGFR降低的风险增加79%（P=0.029）相关。在非aTRH患者中，未发现BPC与肾脏结局之间存在关联。
在3期CKD患者中，aTRH的存在导致eGFR更快丧失。应实施更有效的aTRH预防措施，因为这种情况与严格降低血压无法改变的风险负担相关。
