白大衣高血压与非透析慢性肾脏病患者的终末期肾病事件：来自 C-STRIDE 研究的结果。
White-coat hypertension and incident end-stage renal disease in patients with non-dialysis chronic kidney disease: results from the C-STRIDE Study.
机构信息
Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, National Health and Family Planning Commission of the People's Republic of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment, Ministry of Education, Beijing, 100034, China.
Center for Data Science in Health and Medicine, Peking University, Beijing, China.
出版信息
J Transl Med. 2020 Jun 15;18(1):238. doi: 10.1186/s12967-020-02413-w.
BACKGROUND
Controversy remains whether white coat hypertension (WCH) is associated with renal prognosis in patients with chronic kidney disease (CKD).
METHODS
In the present multicenter, prospective study, we analyzed data of participants with CKD stage 1-4 from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). WCH was defined according to two criteria as follows: A, clinical blood pressure (BP) ≥ 140/90 mm Hg and average 24-h ambulatory BP < 130/80 mm Hg; B, clinical BP ≥ 130/80 mm Hg and daytime ambulatory BP < 130/80 mm Hg. Renal outcome was defined as initiation of renal replacement therapy. The association of WCH with renal events was evaluated by Cox regression model.
RESULTS
A total of 1714 patients with CKD were included in the present analysis. The mean age of the population was 48.9 ± 13.8 years and 56.8% were men. The mean baseline estimated glomerular filtration rate (eGFR) was 52.2 ± 30.1 ml/min/1.73 m and urinary protein was 1.0 (0.4, 2.4) g/day. The overall prevalence of WCH was 4.7% and 16.6% according to criteria A and B, respectively. Incidence rates of renal events were 49.58 and 26.51 according to criteria A and B, respectively, per 1000 person-years during a median follow-up of 4.8 years. After full adjustment, WCH was associated with an increased risk of renal event (criterion A: hazard ratio 2.36, 95% confidence interval 1.29-4.34; for criterion B: hazard ratio 1.90, 95% confidence interval 1.04-3.49) compared with patients with normal BP.
CONCLUSIONS
WCH is associated with a greater risk for renal events in non-dialysis dependent Chinese patients with CKD.
背景
白大衣高血压（WCH）是否与慢性肾脏病（CKD）患者的肾脏预后相关仍存在争议。
方法
在这项多中心前瞻性研究中，我们分析了来自中国慢性肾脏病队列研究（C-STRIDE）的 CKD 1-4 期患者的数据。WCH 根据以下两个标准定义：A，临床血压（BP）≥140/90 mmHg 且平均 24 小时动态血压<130/80 mmHg；B，临床 BP≥130/80 mmHg 且日间动态血压<130/80 mmHg。肾脏结局定义为开始肾脏替代治疗。采用 Cox 回归模型评估 WCH 与肾脏事件的关系。
结果
本分析共纳入 1714 例 CKD 患者。人群平均年龄为 48.9±13.8 岁，56.8%为男性。基线估计肾小球滤过率（eGFR）平均为 52.2±30.1 ml/min/1.73 m，尿蛋白为 1.0（0.4，2.4）g/天。根据标准 A 和 B，WCH 的总体患病率分别为 4.7%和 16.6%。在中位随访 4.8 年后，根据标准 A 和 B，肾脏事件的发生率分别为每 1000 人年 49.58 和 26.51。在充分调整后，与正常血压患者相比，WCH 与肾脏事件的发生风险增加相关（标准 A：危险比 2.36，95%置信区间 1.29-4.34；标准 B：危险比 1.90，95%置信区间 1.04-3.49）。
结论
在非透析依赖的中国 CKD 患者中，WCH 与肾脏事件风险增加相关。
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