MEHTARISC Group, Unitat de Suport a la Recerca Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain.
Department of Medical Sciences, University of Girona, Girona, Spain.
Am J Hypertens. 2019 Aug 14;32(9):890-899. doi: 10.1093/ajh/hpz029.
Our objective of this study was to determine if rate of estimated glomerular filtration rate (eGFR) decline and its intensity was associated with cardiovascular risk and death in patients with hypertension whose baseline eGFR was higher than 60 ml/minute/1.73 m2.
This study comprised 2,516 patients with hypertension who had had at least 2 serum creatinine measurements over a 4-year period. An eGFR reduction of ≥10% per year has been deemed as high eGFR and a reduction in eGFR of less than 10% per year as a low decline. The end points were coronary artery disease, stroke, transitory ischemic accident, peripheral arterial disease, heart failure, atrial fibrillation, and death from any cause. Cox regression analyses adjusted for potentially confounding factors were conducted.
A total of 2,354 patients with low rate of eGFR decline and 149 with high rate of eGFR decline were analyzed. The adjusted model shows that a -10% rate of eGFR decline per year is associated with a higher risk of the primary end point (HR 1.9; 95% CI 1.1-3.5; P = 0.02) and arteriosclerotic vascular disease (HR 2.2; 95% CI 1.2-4.2; P < 0.001) in all hypertensive groups. The variables associated to high/low rate of eGFR decline in the logistic regression model were serum creatinine (OR 3.35; P < 0.001), gender, women (OR 15.3; P < 0.001), tobacco user (OR 1.9; P < 0.002), and pulse pressure (OR 0.99; P < 0.05).
A rate of eGFR decline equal to or higher than -10% per year is a marker of cardiovascular risk for patients with arterial hypertension without chronic kidney disease at baseline. It may be useful to consider intensifying the global risk approach for these patients.
本研究的目的是确定在基线肾小球滤过率（eGFR）高于 60 ml/min/1.73 m2 的高血压患者中，eGFR 下降的速度及其强度是否与心血管风险和死亡相关。
这项研究包括了 2516 名高血压患者，这些患者在 4 年内至少进行了 2 次血清肌酐测量。每年 eGFR 下降≥10%被认为是 eGFR 高下降，而 eGFR 下降速度低于 10%被认为是低下降。终点为冠状动脉疾病、中风、短暂性脑缺血发作、外周动脉疾病、心力衰竭、心房颤动以及任何原因导致的死亡。进行了调整潜在混杂因素的 Cox 回归分析。
共分析了 2354 名 eGFR 下降速度较慢的患者和 149 名 eGFR 下降速度较快的患者。调整后的模型显示，每年 eGFR 下降-10%与主要终点（HR 1.9；95%CI 1.1-3.5；P=0.02）和动脉粥样硬化性血管疾病（HR 2.2；95%CI 1.2-4.2；P<0.001）的风险增加相关。在所有高血压患者中，与 eGFR 高/低下降率相关的变量包括血清肌酐（OR 3.35；P<0.001）、性别、女性（OR 15.3；P<0.001）、吸烟者（OR 1.9；P<0.002）和脉压（OR 0.99；P<0.05）。
每年 eGFR 下降速度等于或高于-10%是基线无慢性肾脏病的高血压患者心血管风险的标志物。对于这些患者，强化整体风险方法可能是有用的。
