Jackson Heart Study, Jackson State University, Jackson, Mississippi.
Departments of Epidemiology and.
Clin J Am Soc Nephrol. 2020 Apr 7;15(4):501-510. doi: 10.2215/CJN.08840719. Epub 2020 Mar 26.
Recent guidelines recommend out-of-clinic BP measurements.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We compared the prevalence of BP phenotypes between 561 black patients, with and without CKD, taking antihypertensive medication who underwent ambulatory BP monitoring at baseline (between 2000 and 2004) in the Jackson Heart Study. CKD was defined as an albumin-to-creatinine ratio ≥30 mg/g or eGFR <60 ml/min per 1.73 m. Sustained controlled BP was defined by BP at goal both inside and outside of the clinic and sustained uncontrolled BP as BP above goal both inside and outside of the clinic. Masked uncontrolled hypertension was defined by controlled clinic-measured BP with uncontrolled out-of-clinic BP.
CKD was associated with a higher multivariable-adjusted prevalence ratio for uncontrolled versus controlled clinic BP (prevalence ratio, 1.44; 95% CI, 1.02 to 2.02) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 1.66; 95% CI, 1.16 to 2.36). There were no statistically significant differences in the prevalence of uncontrolled daytime or nighttime BP, nondipping BP, white-coat effect, and masked uncontrolled hypertension between participants with and without CKD after multivariable adjustment. After multivariable adjustment, reduced eGFR was associated with masked uncontrolled hypertension versus sustained controlled BP (prevalence ratio, 1.42; 95% CI, 1.00 to 2.00), whereas albuminuria was associated with uncontrolled clinic BP (prevalence ratio, 1.76; 95% CI, 1.20 to 2.60) and sustained uncontrolled BP versus sustained controlled BP (prevalence ratio, 2.02; 95% CI, 1.36 to 2.99).
The prevalence of BP phenotypes defined using ambulatory BP monitoring is high among adults with CKD taking antihypertensive medication.
近期指南建议进行诊室外血压测量。
设计、地点、参与者和测量方法：我们比较了在 Jackson 心脏研究中，561 名正在服用降压药物的黑人患者（其中有和没有 CKD）在基线时（2000 年至 2004 年间）接受动态血压监测时的血压表型患病率。CKD 的定义为白蛋白/肌酐比值≥30mg/g 或 eGFR<60ml/min/1.73m。持续控制的血压定义为诊室内外血压均达到目标值，而持续未控制的血压定义为诊室内外血压均高于目标值。隐匿性未控制的高血压定义为诊室测量血压控制，但诊室外血压未控制。
CKD 与未控制与控制的诊室血压相比，多变量校正后的患病率比值更高（患病率比值，1.44；95%CI，1.02 至 2.02），持续未控制与持续控制的血压相比，患病率比值更高（患病率比值，1.66；95%CI，1.16 至 2.36）。经过多变量校正后，CKD 患者与无 CKD 患者之间，在未控制的日间或夜间血压、非杓型血压、白大衣效应和隐匿性未控制的高血压的患病率方面无统计学差异。eGFR 降低与隐匿性未控制的高血压与持续控制的血压相比，多变量校正后的患病率比值更高（患病率比值，1.42；95%CI，1.00 至 2.00），而白蛋白尿与诊室血压未控制（患病率比值，1.76；95%CI，1.20 至 2.60）和持续未控制与持续控制的血压相比，多变量校正后的患病率比值更高（患病率比值，2.02；95%CI，1.36 至 2.99）。
在服用降压药物的 CKD 成年人中，使用动态血压监测定义的血压表型患病率较高。
