Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
Department of Policy Research Affairs, National Health Insurance Service Medical Center, Ilsan Hospital, Goyangshi, Gyeonggi-do, Republic of Korea.
Am J Kidney Dis. 2020 Aug;76(2):224-232. doi: 10.1053/j.ajkd.2020.01.013. Epub 2020 Apr 15.
RATIONALE & OBJECTIVE: Clinical practice guidelines recommend a target blood pressure (BP)<130/80 mm Hg to reduce cardiovascular risk. However, the optimal BP to prevent chronic kidney disease (CKD) is unknown.
Population-based retrospective cohort study.
SETTING & PARTICIPANTS: 10.5 million adults who participated in the National Health Insurance Service National Health Checkup Program in South Korea between 2009 and 2015 and had an estimated glomerular filtration rate (GFR) ≥ 60 mL/min/1.73 m at the beginning of follow-up.
Baseline and time-updated systolic BP (SBP) as a continuous variable and categorized as<110, 110 to 119, 120 to 129, 130 to 139, or≥140 mm Hg.
Incident CKD GFR categories 3 to 5 (CKD G3-G5), defined as de novo development of estimated GFR<60 mL/min/1.73 m for at least 2 consecutive assessments confirmed at least 90 days apart.
Cox proportional hazards regression for baseline BP and marginal structural analysis for time-updated BP.
During 49,169,311 person-years of follow-up, incident CKD G3-G5 developed in 172,423 (1.64%) individuals with a crude event rate of 3.51 (95% CI, 3.49-3.52) per 1,000 person-years. Compared to a baseline SBP of 120 to 129 mm Hg, HRs for incident CKD G3-G5 for the<110, 110 to 119, 130 to 139, and≥140 mm Hg categories were 0.84 (95% CI, 0.82-0.85), 0.92 (95% CI, 0.91-0.94), 1.11 (95% CI, 1.09-1.12), and 1.30 (95% CI, 1.28-1.31), respectively. For time-updated SBPs, corresponding HRs were 0.57 (95% CI, 0.56-0.59), 0.79 (95% CI, 0.78-0.80), 1.58 (95% CI, 1.55-1.60), and 2.49 (95% CI, 2.45-2.53), respectively. Treated as a continuous exposure, each 10-mm Hg higher SBP was associated with 35% higher risk for incident CKD G3-G5 (95% CI, 1.35-1.36).
Use of International Classification of Diseases codes to assess comorbid condition burden; residual confounding, and potential selection bias cannot be excluded.
In this large national cohort study, higher SBPs were associated with higher risk for incident CKD G3-G5. These findings support evaluation of SBP-lowering strategies to reduce the development of CKD.
临床实践指南建议将血压（BP）目标值<130/80mmHg 作为降低心血管风险的标准。然而，预防慢性肾脏病（CKD）的最佳血压值仍不清楚。
基于人群的回顾性队列研究。
韩国全民健康保险服务国家健康检查计划于 2009 年至 2015 年间纳入了 1050 万成年人，在随访开始时估计肾小球滤过率（GFR）≥60ml/min/1.73m2。
基线和时间更新的收缩压（SBP）作为连续变量，并分为<110、110-119、120-129、130-139 或≥140mmHg。
新发 CKD GFR 3-5 期（CKD G3-G5），定义为至少 2 次连续评估证实 GFR<60ml/min/1.73m2，且两次评估间隔至少 90 天。
基线 SBP 采用 Cox 比例风险回归，时间更新 SBP 采用边缘结构分析。
在 49169311 人年的随访期间，172423 名（1.64%）患者发生了 CKD G3-G5，粗发病率为 3.51（95%CI，3.49-3.52）/1000 人年。与基线 SBP 为 120-129mmHg 相比，SBP<110mmHg、110-119mmHg、130-139mmHg 和≥140mmHg 组发生 CKD G3-G5 的 HR 分别为 0.84（95%CI，0.82-0.85）、0.92（95%CI，0.91-0.94）、1.11（95%CI，1.09-1.12）和 1.30（95%CI，1.28-1.31）。对于时间更新的 SBP，相应的 HR 分别为 0.57（95%CI，0.56-0.59）、0.79（95%CI，0.78-0.80）、1.58（95%CI，1.55-1.60）和 2.49（95%CI，2.45-2.53）。将 SBP 视为连续暴露因素，每升高 10mmHg，新发 CKD G3-G5 的风险增加 35%（95%CI，1.35-1.36）。
使用国际疾病分类代码评估合并症负担；无法排除残余混杂因素和潜在的选择偏倚。
在这项大型全国队列研究中，较高的 SBP 与新发 CKD G3-G5 的风险增加相关。这些发现支持评估降压策略以降低 CKD 的发生风险。
