伴有和不伴有蛋白尿的患者强化血压控制的效果：SPRINT 分析。
Effects of Intensive Blood Pressure Control in Patients with and without Albuminuria: Analyses from SPRINT.
机构信息
Kidney Health Research Institute, Department of Population Health Sciences, Geisinger Health System, Danville, Pennsylvania.
Division of Nephrology, Loyola University Medical Center, Maywood, Illinois.
出版信息
Clin J Am Soc Nephrol. 2020 Aug 7;15(8):1121-1128. doi: 10.2215/CJN.12371019. Epub 2020 Jul 15.
BACKGROUND AND OBJECTIVES
It is unclear whether the presence of albuminuria modifies the effects of intensive systolic BP control on risk of eGFR decline, cardiovascular events, or mortality.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The Systolic Blood Pressure Intervention Trial randomized nondiabetic adults ≥50 years of age at high cardiovascular risk to a systolic BP target of <120 or <140 mm Hg, measured by automated office BP. We compared the absolute risk differences and hazard ratios of ≥40% eGFR decline, the Systolic Blood Pressure Intervention Trial primary cardiovascular composite outcome, and all-cause death in those with or without baseline albuminuria (urine albumin-creatinine ratio ≥30 mg/g).
RESULTS
Over a median follow-up of 3.1 years, 69 of 1723 (4%) participants with baseline albuminuria developed ≥40% eGFR decline compared with 61 of 7162 (1%) participants without albuminuria. Incidence rates of ≥40% eGFR decline were higher in participants with albuminuria (intensive, 1.74 per 100 person-years; standard, 1.17 per 100 person-years) than in participants without albuminuria (intensive, 0.48 per 100 person-years; standard, 0.11 per 100 person-years). Although effects of intensive BP lowering on ≥40% eGFR decline varied by albuminuria on the relative scale (hazard ratio, 1.48; 95% confidence interval, 0.91 to 2.39 for albumin-creatinine ratio ≥30 mg/g; hazard ratio, 4.55; 95% confidence interval, 2.37 to 8.75 for albumin-creatinine ratio <30 mg/g; value for interaction <0.001), the absolute increase in ≥40% eGFR decline did not differ by baseline albuminuria (incidence difference, 0.38 events per 100 person-years for albumin-creatinine ratio ≥30 mg/g; incidence difference, 0.58 events per 100 person-years for albumin-creatinine ratio <30 mg/g; value for interaction =0.60). Albuminuria did not significantly modify the beneficial effects of intensive systolic BP lowering on cardiovascular events or mortality evaluated on relative or absolute scales.
CONCLUSIONS
Albuminuria did not modify the absolute benefits and risks of intensive systolic BP lowering.
背景与目的
目前尚不清楚蛋白尿的存在是否会改变强化收缩压控制对 eGFR 下降、心血管事件或死亡率的影响。
设计、环境、参与者和测量方法：Systolic Blood Pressure Intervention Trial 将年龄≥50 岁、心血管风险较高的非糖尿病成年人随机分为收缩压目标<120mmHg 或<140mmHg 的组，通过自动诊室血压测量。我们比较了有或无基线蛋白尿（尿白蛋白/肌酐比值≥30mg/g）患者中≥40%eGFR 下降、Systolic Blood Pressure Intervention Trial 主要心血管复合终点和全因死亡的绝对风险差异和风险比。
结果
中位随访 3.1 年后，基线有蛋白尿的 1723 名参与者中有 69 名（4%）发生≥40%eGFR 下降，而无蛋白尿的 7162 名参与者中有 61 名（1%）发生。有蛋白尿的参与者中≥40%eGFR 下降的发生率较高（强化组为 1.74/100 人年，标准组为 1.17/100 人年），而无蛋白尿的参与者中发生率较低（强化组为 0.48/100 人年，标准组为 0.11/100 人年）。尽管强化降压对蛋白尿的相对水平上的≥40%eGFR 下降的影响不同（风险比，1.48；95%置信区间，0.91 至 2.39，尿白蛋白/肌酐比值≥30mg/g；风险比，4.55；95%置信区间，2.37 至 8.75，尿白蛋白/肌酐比值<30mg/g；交互检验值<0.001），但基线蛋白尿对≥40%eGFR 下降的绝对增加没有影响（发生率差异，尿白蛋白/肌酐比值≥30mg/g 为 0.38 例/100 人年，尿白蛋白/肌酐比值<30mg/g 为 0.58 例/100 人年；交互检验值=0.60）。蛋白尿并未显著改变强化收缩压降低对心血管事件或死亡率的相对或绝对获益。
结论
蛋白尿并未改变强化收缩压降低的绝对获益和风险。
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