Department of Pharmacology and Molecular Therapeutics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Hypertens Res. 2019 Jun;42(6):883-891. doi: 10.1038/s41440-019-0210-1. Epub 2019 Jan 21.
To investigate whether anemia is an independent risk factor for cardiovascular and renal events in hypertensive outpatients, we performed a subgroup analysis of the ATTEMPT-CVD study based on baseline hemoglobin. The ATTEMPT-CVD study was a multicenter, prospective, randomized study of hypertensive outpatients that compared the efficacy of angiotensin receptor blocker (ARB)-based antihypertensive treatment with non-ARB antihypertensive treatment over 3 years. In the present subanalysis, ATTEMPT-CVD study participants (n = 1213) were categorized into the anemic group and nonanemic group according to their baseline hemoglobin. We compared the anemic and nonanemic groups mainly in regard to the incidence of cardiovascular and renal events and blood pressure. We also performed a multivariable Cox proportional hazards analysis to determine the prognostic factors that were independently associated with cardiovascular and renal events. Of the 1213 patients enrolled in the ATTEMPT-CVD, 194 patients had anemia (mostly mild anemia) and 1019 patients did not. Blood pressure was well-controlled during the 3 years of antihypertensive therapy in both the anemic and nonanemic groups. However, the incidence of cardiovascular and renal events was significantly greater in the anemic group than in the nonanemic group (HR = 1.945: 95%CI 1.208-3.130; P = 0.0062). Even after adjustment, anemia was independently associated with cardiovascular and renal events (HR = 1.816: 95%CI 1.116-2.955; P = 0.0163) in overall hypertensive patients with well-controlled blood pressure. Anemia, even mild anemia, is an independent risk factor for cardiovascular and renal events in hypertensive outpatients whose blood pressure is well-controlled. Thus, anemia may be a novel therapeutic target for cardiovascular and renal diseases in hypertensive outpatients with anemia.
为了探究贫血是否是高血压门诊患者心血管和肾脏事件的独立危险因素，我们根据基线血红蛋白对 ATTEMPT-CVD 研究进行了亚组分析。ATTEMPT-CVD 研究是一项多中心、前瞻性、随机研究，比较了 3 年期间血管紧张素受体阻滞剂（ARB）为基础的降压治疗与非 ARB 降压治疗在高血压门诊患者中的疗效。在本亚组分析中，根据基线血红蛋白将 ATTEMPT-CVD 研究参与者（n=1213）分为贫血组和非贫血组。我们主要比较了两组患者心血管和肾脏事件的发生率以及血压。我们还进行了多变量 Cox 比例风险分析，以确定与心血管和肾脏事件独立相关的预后因素。在纳入 ATTEMPT-CVD 的 1213 例患者中，有 194 例患者存在贫血（主要为轻度贫血），1019 例患者无贫血。在降压治疗的 3 年内，贫血组和非贫血组的血压均得到良好控制。然而，贫血组心血管和肾脏事件的发生率明显高于非贫血组（HR=1.945：95%CI 1.208-3.130；P=0.0062）。即使在调整后，贫血与心血管和肾脏事件仍独立相关（HR=1.816：95%CI 1.116-2.955；P=0.0163），即使在血压得到良好控制的总体高血压患者中也是如此。在血压得到良好控制的贫血高血压门诊患者中，即使是轻度贫血，也是心血管和肾脏事件的独立危险因素。因此，贫血可能是贫血高血压门诊患者心血管和肾脏疾病的一个新的治疗靶点。
