Katz Family and Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Division of Population Health and Computational Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA.
Am J Nephrol. 2019;49(4):297-306. doi: 10.1159/000499188. Epub 2019 Mar 27.
Management of chronic kidney disease (CKD) patients includes efforts directed toward modifying traditional cardiovascular risk factors. Such efforts include optimal management of hypertension together with the initiation of statin therapy.
In this observational study, we determine the modifying effect of statins on the relationship of systolic blood pressure (SBP) goal with mortality and other outcomes in patients with CKD participating in a clinical trial. At baseline, 2,646 CKD patients (estimated glomerular filtration rate < 60 mL/min/1.73 m2) were randomized to an intensive SBP goal < 120 mm Hg or standard SBP goal <140 mm Hg. One thousand two hundred and seventy-three were not on statin, 1,354 were on a statin, and in 19 the use of statin was unknown. The 2 primary outcomes were all-cause mortality and cardiovascular disease (CVD) mortality.
The relationships of SBP goal with all-cause mortality (interaction p = 0.009) and cardiovascular (CV) mortality (interaction p = 0.021) were modified by the use of statin after adjusting for age, gender, race, CVD history, smoking, aspirin use, and blood pressure at baseline. In the statin group, targeting SBP to < 120 mm Hg compared to SBP < 140 mm Hg significantly reduced the risk of all-cause mortality (adjusted hazard ratio [aHR] 0.44 [0.28-0.71]; event rates 1.16 vs. 2.5 per 100 patient-years) and CV mortality (aHR 0.29 [0.12-0.74]; event rates 0.28 vs. 0.92 per 100 patient-years) after a median follow-up of 3.26 years. In the non-statin group, the risk of all-cause mortality (aHR 1.07 [0.69-1.66]; event rates 2.01 vs. 1.94 per 100 patient-years) and CV mortality (aHR 1.42 [0.56-3.59]; event rates 0.52 vs. 0.41 per 100 patient-years) were not significantly different in both SBP goal arms.
The combination of statin therapy and intensive SBP management leads to improved survival in hypertensive patients with CKD.
慢性肾脏病（CKD）患者的管理包括努力改变传统的心血管危险因素。这些措施包括最佳控制高血压和启动他汀类药物治疗。
在这项观察性研究中，我们确定了他汀类药物对临床试验中接受治疗的 CKD 患者收缩压（SBP）目标与死亡率和其他结局之间关系的调节作用。在基线时，2646 例 CKD 患者（估计肾小球滤过率 < 60 ml/min/1.73 m2）被随机分配到强化 SBP 目标 < 120 mmHg 或标准 SBP 目标 < 140 mmHg。1273 例患者未服用他汀类药物，1354 例患者服用他汀类药物，19 例患者服用他汀类药物情况未知。主要结局为全因死亡率和心血管疾病（CVD）死亡率。
在调整年龄、性别、种族、CVD 病史、吸烟、阿司匹林使用和基线血压后，SBP 目标与全因死亡率（交互 p = 0.009）和心血管死亡率（交互 p = 0.021）的关系受到他汀类药物使用的调节。在他汀类药物组中，与 SBP < 140 mmHg 相比，将 SBP 目标控制在 < 120 mmHg 可显著降低全因死亡率（调整后的危险比 [aHR] 0.44 [0.28-0.71]；事件率为每 100 患者年 1.16 与 2.5）和心血管死亡率（aHR 0.29 [0.12-0.74]；事件率为每 100 患者年 0.28 与 0.92），中位随访 3.26 年后。在非他汀类药物组中，SBP 目标两个臂之间的全因死亡率（aHR 1.07 [0.69-1.66]；事件率为每 100 患者年 2.01 与 1.94）和心血管死亡率（aHR 1.42 [0.56-3.59]；事件率为每 100 患者年 0.52 与 0.41）风险无显著差异。
他汀类药物治疗联合强化 SBP 管理可改善高血压合并 CKD 患者的生存。
