Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA.
Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA.
Nephrol Dial Transplant. 2020 Aug 1;35(8):1377-1384. doi: 10.1093/ndt/gfz149.
Low serum bicarbonate level is associated with increased mortality, but its role as a predictor of cardiovascular disease (CVD) is unclear. This study evaluates the association between serum bicarbonate concentration and CVD and whether the effect of intensive blood pressure (BP) lowering on CVD outcomes is modified by serum bicarbonate level.
The Systolic Blood Pressure Intervention Trial (SPRINT) randomized participants to a systolic BP target <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). The primary CVD outcome was a composite of nonfatal myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and CVD death. Cox proportional hazards models adjusted for demographic, clinical and laboratory characteristics were used to evaluate the association of interest in 9334 SPRINT participants (ClinicalTrials.gov: NCT01206062).
Over a median follow-up of 3.33 years (interquartile range 2.87-3.87 years), 618 (6.6%) participants experienced a primary CVD outcome. Participants with serum bicarbonate <22 mEq/L had a significantly higher risk of the primary CVD outcome (hazard ratio 1.54; 95% confidence interval 1.11-2.14, P = 0.01), compared with participants with bicarbonate 22-26 mEq/L. The magnitude of the CVD risk reduction with intensive BP lowering was similar across bicarbonate strata (P-value for interaction = 0.97).
In hypertensive individuals, serum bicarbonate level <22 mEq/L was associated with an increased CVD risk. The effect of intensive BP lowering on CVD outcomes was not modified by the serum bicarbonate level.
血清碳酸氢盐水平较低与死亡率增加相关，但它作为心血管疾病（CVD）预测因子的作用尚不清楚。本研究评估了血清碳酸氢盐浓度与 CVD 的关系，以及强化降压对 CVD 结局的影响是否受血清碳酸氢盐水平的影响。
收缩压干预试验（SPRINT）将参与者随机分配至收缩压目标<120mmHg（强化治疗）或<140mmHg（标准治疗）。主要 CVD 结局是复合终点，包括非致死性心肌梗死（MI）、非 MI 的急性冠状动脉综合征、卒中等。使用 Cox 比例风险模型调整人口统计学、临床和实验室特征，对 9334 名 SPRINT 参与者（ClinicalTrials.gov：NCT01206062）进行了评估。
中位随访 3.33 年（四分位间距 2.87-3.87 年）期间，618 名（6.6%）参与者发生了主要 CVD 结局。血清碳酸氢盐<22 mEq/L 的参与者主要 CVD 结局风险显著升高（风险比 1.54；95%置信区间 1.11-2.14，P=0.01），与碳酸氢盐 22-26 mEq/L 的参与者相比。强化降压对 CVD 结局的风险降低幅度在碳酸氢盐各层之间相似（交互检验 P 值=0.97）。
在高血压个体中，血清碳酸氢盐水平<22 mEq/L 与 CVD 风险增加相关。强化降压对 CVD 结局的影响不受血清碳酸氢盐水平的影响。
