动态血压负荷在儿科 CKD 中的预后价值。
Prognostic Value of Ambulatory Blood Pressure Load in Pediatric CKD.
机构信息
Division of Pediatric Nephrology, University of California San Francisco, San Francisco, California.
Department of Pediatrics, University of California San Francisco, San Francisco, California.
出版信息
Clin J Am Soc Nephrol. 2020 Apr 7;15(4):493-500. doi: 10.2215/CJN.10130819. Epub 2020 Mar 11.
BACKGROUND AND OBJECTIVES
Elevated BP load is part of the criteria for ambulatory hypertension in pediatric but not adult guidelines. Our objectives were to determine the prevalence of isolated BP load elevation and associated risk with adverse outcomes in children with CKD, and to ascertain whether BP load offers risk discrimination independently or in conjunction with mean ambulatory BPs.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We studied 533 children in the CKD in Children (CKiD) Study to determine the prevalence of normotension, isolated BP load elevation (≥25% of all readings elevated but mean BP normal), and ambulatory hypertension. We examined the association between these categories of BP control and adverse outcomes (left ventricular hypertrophy [LVH] or ESKD). We used c-statistics to determine risk discrimination for outcomes by BP load used either independently or in conjunction with other BP parameters.
RESULTS
Overall, 23% of the cohort had isolated BP load elevation, but isolated BP load elevation was not statistically significantly associated with LVH in cross-section (odds ratio, 1.8; 95% CI, 0.8 to 4.2) or time to ESKD (hazard ratio, 1.2; 95% CI, 0.7 to 2.0). In unadjusted cross-sectional analysis, every 10% higher systolic BP load was associated with 1.1-times higher odds of LVH (95% CI, 1.0 to 1.3), but discrimination for LVH was poor (c=0.61). In unadjusted longitudinal analysis, every 10% higher systolic BP load was associated with a 1.2-times higher risk of ESKD (95% CI, 1.1 to 1.2), but discrimination for ESKD was also poor (c=0.60). After accounting for mean systolic BP, systolic BP load was not statistically significantly associated with either LVH or ESKD. Findings were similar with diastolic BP load.
CONCLUSIONS
BP load does not provide additive value in discriminating outcomes when used independently or in conjunction with mean systolic BP in children with CKD.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_03_11_CPOD10130819.mp3.
背景和目的
血压负荷升高是儿科而非成人动态血压监测指南中定义的门诊高血压标准之一。我们的目标是确定在患有 CKD 的儿童中，孤立性血压负荷升高的患病率及其与不良结局相关的风险，以及确定血压负荷升高是否能独立或结合平均动态血压提供风险区分。
设计、地点、参与者和测量方法：我们研究了 CKiD 研究中的 533 名儿童，以确定正常血压、孤立性血压负荷升高（≥25%的读数升高，但平均血压正常）和动态高血压的患病率。我们检查了这些血压控制类别与不良结局（左心室肥厚[LVH]或终末期肾病[ESKD]）之间的关系。我们使用 C 统计量来确定血压负荷升高在独立或结合其他血压参数时对结局的风险区分能力。
结果
总体而言，队列中有 23%的儿童存在孤立性血压负荷升高，但孤立性血压负荷升高与横断面 LVH（比值比，1.8；95%置信区间，0.8 至 4.2）或进展为 ESKD 的时间（风险比，1.2；95%置信区间，0.7 至 2.0）无统计学显著相关性。在未经调整的横断面分析中，收缩压负荷每增加 10%，LVH 的可能性就会增加 1.1 倍（95%置信区间，1.0 至 1.3），但对 LVH 的区分能力较差（C=0.61）。在未经调整的纵向分析中，收缩压负荷每增加 10%，ESKD 的风险就会增加 1.2 倍（95%置信区间，1.1 至 1.2），但对 ESKD 的区分能力也较差（C=0.60）。在考虑平均收缩压后，收缩压负荷与 LVH 或 ESKD 均无统计学显著相关性。舒张压负荷也有类似的结果。
结论
在患有 CKD 的儿童中，BP 负荷升高在独立使用或与平均收缩压联合使用时，在区分结局方面没有提供附加价值。
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