Division of Nephrology Department of Medicine University of California San Francisco San Francisco, CA.
Division of Pediatric Nephrology Department of Pediatrics University of California San Francisco San Francisco, CA.
J Am Heart Assoc. 2019 Aug 20;8(16):e012749. doi: 10.1161/JAHA.119.012749. Epub 2019 Aug 14.
Background Our objective was to explore the effect of intensive blood pressure (BP) control on kidney and death outcomes among subgroups of patients with chronic kidney disease divided by baseline proteinuria, glomerular filtration rate, age, and body mass index. Methods and Results We included 840 MDRD (Modification of Diet in Renal Disease) trial and 1067 AASK (African American Study of Kidney Disease and Hypertension) participants. We used Cox models to examine whether the association between intensive BP control and risk of end-stage renal disease (ESRD) or death is modified by baseline proteinuria (≥0.44 versus <0.44 g/g), glomerular filtration rate (≥30 versus <30 mL/min per 1.73 m), age (≥40 versus <40 years), or body mass index (≥30 versus <30 kg/m). The median follow-up was 14.9 years. Strict (versus usual) BP control was protective against ESRD (hazard ratio [HR], 0.77; 95% CI, 0.64-0.92) among those with proteinuria ≥0.44 g/g but not proteinuria <0.44 g/g. Strict (versus usual) BP control was protective against death (HR, 0.73; 95% CI, 0.59-0.92) among those with glomerular filtration rate <30 mL/min per 1.73 m but not glomerular filtration rate ≥30 mL/min per 1.73 m (HR, 0.98; 95% CI, 0.84-1.15). Strict (versus usual) BP control was protective against ESRD among those ≥40 years (HR 0.82; 95% CI, 0.71-0.94) but not <40 years. Strict (versus usual) BP control was also protective against ESRD among those with body mass index ≥30 kg/m (HR 0.75; 95% CI, 0.61-0.92) but not body mass index <30 kg/m. Conclusions The ESRD and all-cause mortality benefits of intensive BP lowering may not be uniform across all subgroups of patients with chronic kidney disease. But intensive BP lowering was not associated with increased risk of ESRD or death among any subgroups that we examined.
我们的目的是探讨强化血压（BP）控制对按基线蛋白尿、肾小球滤过率、年龄和体重指数分组的慢性肾脏病患者的肾脏和死亡结局的影响。
我们纳入了 MDRD（肾脏疾病饮食改良研究）试验中的 840 名参与者和 AASK（非裔美国人肾脏病和高血压研究）中的 1067 名参与者。我们使用 Cox 模型来检验强化 BP 控制与终末期肾脏疾病（ESRD）或死亡风险之间的关联是否因基线蛋白尿（≥0.44 与 <0.44 g/g）、肾小球滤过率（≥30 与 <30 mL/min/1.73 m）、年龄（≥40 与 <40 岁）或体重指数（≥30 与 <30 kg/m）而有所改变。中位随访时间为 14.9 年。严格（与常规）BP 控制对蛋白尿≥0.44 g/g 的患者具有保护作用，可降低 ESRD 风险（危险比[HR]，0.77；95%置信区间，0.64-0.92），但对蛋白尿<0.44 g/g 的患者没有保护作用。严格（与常规）BP 控制对肾小球滤过率<30 mL/min/1.73 m 的患者具有保护作用，可降低死亡风险（HR，0.73；95%置信区间，0.59-0.92），但对肾小球滤过率≥30 mL/min/1.73 m 的患者没有保护作用（HR，0.98；95%置信区间，0.84-1.15）。严格（与常规）BP 控制对年龄≥40 岁的患者具有保护作用，可降低 ESRD 风险（HR，0.82；95%置信区间，0.71-0.94），但对年龄<40 岁的患者没有保护作用。严格（与常规）BP 控制对体重指数≥30 kg/m 的患者具有保护作用，可降低 ESRD 风险（HR，0.75；95%置信区间，0.61-0.92），但对体重指数<30 kg/m 的患者没有保护作用。
强化降压对 ESRD 和全因死亡率的益处可能并不适用于所有慢性肾脏病患者亚组。但在我们研究的所有亚组中，强化 BP 降低与 ESRD 或死亡风险的增加无关。
