高血压与肾功能下降的关系：社区动脉粥样硬化风险研究（ARIC）。
Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD.
出版信息
Am J Kidney Dis. 2019 Sep;74(3):310-319. doi: 10.1053/j.ajkd.2019.02.015. Epub 2019 Apr 25.
RATIONALE & OBJECTIVE: The relationship between hypertension, antihypertension medication use, and change in glomerular filtration rate (GFR) over time among individuals with preserved GFR requires investigation.
STUDY DESIGN
Observational study.
SETTING & PARTICIPANTS: 14,854 participants from the Atherosclerosis Risk in Communities (ARIC) Study.
PREDICTORS
Baseline hypertension status (1987-1989) was categorized according to the 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline as normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication.
OUTCOMES
Slope of estimated GFR (eGFR) at 5 study visits over 30 years.
ANALYTICAL APPROACH
Mixed models with random intercepts and random slopes were fit to evaluate the association between baseline hypertension status and slope of eGFR.
RESULTS
At baseline, 13.2%, 7.3%, and 19.4% of whites and 15.8%, 14.9%, and 39.9% of African Americans had stage 1 hypertension, stage 2 hypertension without medication, and stage 2 hypertension with medication. Compared with those with normal blood pressure, the annual eGFR decline was greater in people with higher blood pressure (whites: elevated blood pressure, -0.11mL/min/1.73m; stage 1 hypertension, -0.15mL/min/1.73m; stage 2 hypertension without medication, -0.36mL/min/1.73m; stage 2 hypertension with medication, -0.17mL/min/1.73m; African Americans: elevated blood pressure, -0.21mL/min/1.73m; stage 1 hypertension, -0.16mL/min/1.73m; stage 2 hypertension without medication, -0.50mL/min/1.73m; stage 2 hypertension with medication, -0.16mL/min/1.73m). The 30-year predicted probabilities of developing chronic kidney disease stage G3a+with normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication among whites were 54.4%, 61.6%, 64.7%, 78.1%, and 70.9%, respectively, and 55.4%, 62.8%, 60.9%, 76.1%, and 66.6% among African Americans.
LIMITATIONS
Slope estimated using a maximum of 5 eGFR assessments; differential loss to follow-up.
CONCLUSIONS
Compared to normotension, baseline hypertension status was associated with faster kidney function decline over 30-year follow-up in a general population cohort. This difference was attenuated among people using antihypertensive medications.
背景与目的
需要研究个体肾小球滤过率（GFR）保持不变时，高血压、降压药物使用与 GFR 随时间变化之间的关系。
研究设计
观察性研究。
地点与参与者
来自动脉粥样硬化风险社区（ARIC）研究的 14854 名参与者。
预测因素
根据 2017 年美国心脏病学会/美国心脏协会临床实践指南，将基线高血压状态（1987-1989 年）分为正常血压、血压升高、1 期高血压、无药物治疗的 2 期高血压和有药物治疗的 2 期高血压。
结局
30 年 5 次研究访问时估计肾小球滤过率（eGFR）的斜率。
分析方法
使用具有随机截距和随机斜率的混合模型评估基线高血压状态与 eGFR 斜率之间的关系。
结果
在基线时，13.2%、7.3%和 19.4%的白人以及 15.8%、14.9%和 39.9%的非裔美国人患有 1 期高血压、无药物治疗的 2 期高血压和有药物治疗的 2 期高血压。与正常血压相比，血压较高者的 eGFR 每年下降幅度更大（白人：血压升高，-0.11mL/min/1.73m；1 期高血压，-0.15mL/min/1.73m；无药物治疗的 2 期高血压，-0.36mL/min/1.73m；有药物治疗的 2 期高血压，-0.17mL/min/1.73m；非裔美国人：血压升高，-0.21mL/min/1.73m；1 期高血压，-0.16mL/min/1.73m；无药物治疗的 2 期高血压，-0.50mL/min/1.73m；有药物治疗的 2 期高血压，-0.16mL/min/1.73m）。在白人中，正常血压、血压升高、1 期高血压、无药物治疗的 2 期高血压和有药物治疗的 2 期高血压者在 30 年内发展为慢性肾脏病 G3a+的预测概率分别为 54.4%、61.6%、64.7%、78.1%和 70.9%，而非裔美国人则分别为 55.4%、62.8%、60.9%、76.1%和 66.6%。
局限性
使用最多 5 次 eGFR 评估估计斜率；随访中存在差异的失访。
结论
与正常血压相比，基线高血压状态与一般人群队列中 30 年随访期间肾功能下降较快相关。在使用降压药物的人群中，这种差异减弱。
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