Banerjee Debasish, Plange-Rhule Jacob, Chitalia Nihil, Kumi Kwabena, Micah Frank B, Cappuccio Francesco P, Eastwood John B
Department of Renal Medicine and Transplantation, St Georges, University of London, Cranmer Terrace, London SW17 0RE, UK.
Department of Medicine, Komfo Anokye Teaching Hospital, P. O. Box 134, Kumasi, Ghana.
Int J Hypertens. 2018 Oct 4;2018:7864564. doi: 10.1155/2018/7864564. eCollection 2018.
Hypertension, particularly pulse pressure [PP] is a major risk factor for end-stage renal disease. However, the effect of individual components of hypertension namely PP, systolic [SBP] and diastolic blood pressure [DBP] on kidney function, in the general African population is unknown.
Data were collected on 944 participants [aged 40-75 y], living in villages in the area around the city of Kumasi, Ghana, on demographics, medications, height, weight, BP and 24-hour creatinine clearance (CrCl).
The demographic and clinical characteristics were: age 55(11) [mean (SD)] years, females 62%, rural village-dwellers 52%, diabetes 1·5%, BMI 21(4) kg/m, 24-hourCrCl as a measure of glomerular filtration rate (GFR) 84(23) ml/min/1.73 m. 29% had BP >140/90 mmHg; SBP and DBP were 125/74(26/14) mmHg, PP was 51(17) mmHg. PP increased with age by 0.55(95% CI: 0.46,0.64) mmHg/year. PP was higher (53(17) v 49(15) mmHg; p < 0.001) in the semiurban participants. GFR decreased both with increasing PP [-0.19 (-0.27,-0.10 ml/min/1.73 m/mmHg; p < 0.001] and SBP [-0.09 (-0.14,-0.03) ml/min/1.73 m/mmHg; p < 0.001] but there was no significant relationship with DBP [-0.04 (-0.15,0.06)]. After adjusting for SBP, the relationship between GFR and PP became steeper [-0.31 (-0.50,-0.12) ml/min/1.73 m/mmHg; p < 0.001]. Using multivariate regression analysis that included PP, age, gender, BMI, only increasing age [-0.75 (-0.88,-0.62)] and decreasing BMI [0.49 (0.16,0.81)] were associated with decreased kidney function.
In this homogeneous West-African population, PP increased with age and had a steeper relationship with declining kidney function than SBP or DBP.
高血压，尤其是脉压（PP）是终末期肾病的主要危险因素。然而，在非洲普通人群中，高血压的各个组成部分，即PP、收缩压（SBP）和舒张压（DBP）对肾功能的影响尚不清楚。
收集了居住在加纳库马西市周边地区村庄的944名参与者（年龄40 - 75岁）的人口统计学信息、用药情况、身高、体重、血压和24小时肌酐清除率（CrCl）数据。
人口统计学和临床特征如下：年龄55（11）[均值（标准差）]岁，女性占62%，农村居民占52%，糖尿病患病率1.5%，体重指数（BMI）21（4）kg/m²，以24小时CrCl作为肾小球滤过率（GFR）的衡量指标为84（23）ml/min/1.73m²。29%的人血压>140/90 mmHg；SBP和DBP分别为125/74（26/14）mmHg，PP为51（17）mmHg。PP随年龄增长每年增加0.55（95%置信区间：0.46，0.64）mmHg。半城市参与者的PP更高（53（17）对49（15）mmHg；p<0.001）。GFR随PP升高[-0.19（-0.27，-0.10）ml/min/1.73m²/mmHg；p<0.001]和SBP升高[-0.09（-0.14，-0.03）ml/min/1.73m²/mmHg；p<0.001]均下降，但与DBP无显著关系[-0.04（-0.15，0.06）]。在对SBP进行校正后，GFR与PP之间的关系变得更显著[-0.31（-0.50，-0.12）ml/min/1.73m²/mmHg；p<0.001]。使用包括PP、年龄、性别、BMI的多变量回归分析，仅年龄增长[-0.75（-0.88，-0.62）]和BMI降低[0.49（0.16，0.81）]与肾功能下降相关。
在这个同质化的西非人群中，PP随年龄增长，且与肾功能下降的关系比SBP或DBP更显著。
