Department of Cardiology, The First Hospital of China Medical University, Shenyang, China.
Department of Neurology, The First Hospital of China Medical University, Shenyang, China.
J Clin Hypertens (Greenwich). 2019 Oct;21(10):1567-1577. doi: 10.1111/jch.13673. Epub 2019 Sep 16.
Hypertension and hyperhomocysteinemia are two independent risk factors of chronic kidney disease (CKD). Our study aimed to evaluate whether hypertension and hyperhomocysteinemia act synergistically toward renal injury. Our analysis included 13 693 subjects from the National Health and Nutritional Survey (NHANES) 1999-2006. Association was assessed by multivariate logistic regressions. The interaction was investigated on both additive and multiplicative scales. CKD had a prevalence of 17.62% in the NHANES population. After adjusting for age, sex, race, education, physical activity, drinking frequency, current smoking status, poverty-to-income ratio, Total cholesterol, high-density lipoprotein cholesterol, serum folate, vitamin B12, body mass index, waist circumference, and diabetes mellitus, patients with both hypertension and hyperhomocysteinemia had a 5.072 (3.967-6.486) times risk of CKD than their healthy compartments, higher than that in patients with only hypertension or hyperhomocysteinemia. Moreover, additive interaction of hypertension and hyperhomocysteinemia was significant (relative excess risk due to interaction: 2.107, 95% CI: 1.071-3.143; the attributable proportion due to interaction: 0.415, 95% CI: 0.270-0.561; synergy index: 2.072, 95% CI: 1.449-2.962). Finally, subgroup analyses elucidated the interaction was robust in those with only reduced estimated glomerular filtration rate or albuminuria, and stratification analyses based on gender showed consistency with the main results. Hypertension and hyperhomocysteinemia may act synergistically toward a greater renal injury than the sum of their independent effects. Our findings suggest the coexistence itself also correlates with a deteriorative impact on renal function in addition to the effects of hypertension and diabetes themselves. The results may support the rationality and value of simultaneous tight control of hypertension and hyperhomocysteinemia to prevent CKD.
高血压和高同型半胱氨酸血症是慢性肾脏病（CKD）的两个独立危险因素。我们的研究旨在评估高血压和高同型半胱氨酸血症是否对肾脏损伤有协同作用。我们的分析包括了 1999-2006 年全国健康和营养调查（NHANES）中的 13693 名受试者。采用多变量逻辑回归评估相关性。在加性和乘法尺度上都对交互作用进行了研究。NHANES 人群中 CKD 的患病率为 17.62%。在调整了年龄、性别、种族、教育程度、体力活动、饮酒频率、当前吸烟状况、贫困收入比、总胆固醇、高密度脂蛋白胆固醇、血清叶酸、维生素 B12、体重指数、腰围和糖尿病后，同时患有高血压和高同型半胱氨酸血症的患者患 CKD 的风险是其健康组别的 5.072（3.967-6.486）倍，高于仅患有高血压或高同型半胱氨酸血症的患者。此外，高血压和高同型半胱氨酸血症的相加交互作用具有统计学意义（交互归因超额风险：2.107，95%CI：1.071-3.143；交互归因比例：0.415，95%CI：0.270-0.561；协同指数：2.072，95%CI：1.449-2.962）。最后，亚组分析表明，在仅肾小球滤过率降低或蛋白尿的患者中，交互作用是稳健的，基于性别分层的分析结果与主要结果一致。高血压和高同型半胱氨酸血症可能会协同作用，导致比它们各自独立作用更大的肾脏损伤。我们的研究结果表明，除了高血压和糖尿病本身的作用外，两者的共存本身也与肾功能恶化相关。这些结果可能支持同时严格控制高血压和高同型半胱氨酸血症以预防 CKD 的合理性和价值。
