Department of Epidemiology, Emory University, Atlanta, GA, USA.
Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA.
J Clin Hypertens (Greenwich). 2018 Jun;20(6):1018-1026. doi: 10.1111/jch.13311. Epub 2018 May 23.
While much of the chronic kidney disease (CKD) literature focuses on the role of blood pressure reduction in delaying CKD progression, little is known about the benefits of modest population-wide decrements in blood pressure on incident CKD. The authors used multivariable linear regression to characterize the impact on incident CKD of two approaches for blood pressure management: (1) a 1-mm Hg reduction in systolic BP across the entire study population; and (2) a 10% reduction in participants with unaware, untreated, and uncontrolled BP above goal as defined by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) thresholds. Over a mean of 20 years of follow-up (ARIC [Atherosclerosis Risk in Communities] study, n = 15 390), 3852 incident CKD events were ascertained. After adjustment, a 1-mm Hg decrement in systolic BP across the population was associated with an estimated 11.7 (95% confidence interval [CI], 6.2-17.3) and 13.4 (95% CI, 10.3-16.6) fewer CKD events per 100 000 person-years in blacks and whites, respectively. Among participants with BP above JNC 7 goal, a 10% decrease in unaware, untreated, or uncontrolled BP was associated with 3.2 (95% CI, 2.0-4.9), 2.8 (95% CI, 1.8-4.3), and 5.8 (95% CI, 3.6-8.8) fewer CKD events per 100 000 person-years in blacks and 3.1 (95% CI, 2.3-4.1), 0.7 (95% CI, 0.5-0.9), and 1.0 (95% CI, 1.3-2.4) fewer CKD events per 100 000 person-years in whites. Modest population-wide reductions in systolic BP hold potential for the primary prevention of CKD.
虽然大部分慢性肾脏病 (CKD) 文献都集中在降低血压对延缓 CKD 进展的作用上，但对于适度降低人群血压对新发 CKD 的益处却知之甚少。作者使用多变量线性回归来描述血压管理的两种方法对新发 CKD 的影响：（1）整个研究人群的收缩压降低 1mmHg；（2）根据第七次联合国家委员会预防、检测、评估和治疗高血压报告（JNC 7）阈值，将未经治疗且血压控制不达标的人群的收缩压降低 10%。在平均 20 年的随访期间（社区动脉粥样硬化风险研究，n=15390），确定了 3852 例新发 CKD 事件。调整后，人群中收缩压降低 1mmHg 与黑人中每 10 万人年估计减少 11.7（95%置信区间 [CI]，6.2-17.3）和 13.4（95% CI，10.3-16.6）例 CKD 事件，以及白人中每 10 万人年分别减少 11.7（95% CI，6.2-17.3）和 13.4（95% CI，10.3-16.6）例 CKD 事件相关。在血压高于 JNC 7 目标的参与者中，未察觉、未经治疗或未得到控制的血压降低 10%与黑人中每 10 万人年减少 3.2（95% CI，2.0-4.9）、2.8（95% CI，1.8-4.3）和 5.8（95% CI，3.6-8.8）例 CKD 事件，以及白人中每 10 万人年减少 3.1（95% CI，2.3-4.1）、0.7（95% CI，0.5-0.9）和 1.0（95% CI，1.3-2.4）例 CKD 事件相关。适度降低人群血压可能有助于原发性预防 CKD。
