CKD 患者动态血压监测的预后意义：来自慢性肾功能不全队列（CRIC）研究的报告。
Prognostic Significance of Ambulatory BP Monitoring in CKD: A Report from the Chronic Renal Insufficiency Cohort (CRIC) Study.
机构信息
Division of Nephrology and Hypertension, University Hospitals Cleveland Medical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Case Western Reserve University, Cleveland, Ohio
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
出版信息
J Am Soc Nephrol. 2020 Nov;31(11):2609-2621. doi: 10.1681/ASN.2020030236. Epub 2020 Sep 24.
BACKGROUND
Whether ambulatory BP monitoring is of value in evaluating risk for outcomes in patients with CKD is not clear.
METHODS
We followed 1502 participants of the Chronic Renal Insufficiency Cohort (CRIC) Study for a mean of 6.72 years. We evaluated, as exposures, ambulatory BP monitoring profiles (masked uncontrolled hypertension, white-coat effect, sustained hypertension, and controlled BP), mean ambulatory BP monitoring and clinic BPs, and diurnal variation in BP-reverse dipper (higher at nighttime), nondipper, and dipper (lower at nighttime). Outcomes included cardiovascular disease (a composite of myocardial infarction, cerebrovascular accident, heart failure, and peripheral arterial disease), kidney disease (a composite of ESKD or halving of the eGFR), and mortality.
RESULTS
Compared with having controlled BP, the presence of masked uncontrolled hypertension independently associated with higher risk of the cardiovascular outcome and the kidney outcome, but not with all-cause mortality. Higher mean 24-hour systolic BP associated with higher risk of cardiovascular outcome, kidney outcome, and mortality, independent of clinic BP. Participants with the reverse-dipper profile of diurnal BP variation were at higher risk of the kidney outcome.
CONCLUSIONS
In this cohort of participants with CKD, BP metrics derived from ambulatory BP monitoring are associated with cardiovascular outcomes, kidney outcomes, and mortality, independent of clinic BP. Masked uncontrolled hypertension and mean 24-hour BP associated with high risk of cardiovascular disease and progression of kidney disease. Alterations of diurnal variation in BP are associated with high risk of progression of kidney disease, stroke, and peripheral arterial disease. These data support the wider use of ambulatory BP monitoring in the evaluation of hypertension in patients with CKD.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/JASN/2020_09_24_JASN2020030236.mp3.
背景
动态血压监测在评估慢性肾脏病患者的结局风险方面是否具有价值尚不清楚。
方法
我们对慢性肾功能不全队列研究（CRIC）的 1502 名参与者进行了平均 6.72 年的随访。我们将动态血压监测结果（隐匿性未控制高血压、白大衣效应、持续性高血压和控制血压）、平均动态血压监测和诊室血压以及血压昼夜变化（夜间更高的反向杓型、非杓型和杓型）作为暴露因素进行评估。主要结局包括心血管疾病（心肌梗死、脑血管意外、心力衰竭和外周动脉疾病的综合）、肾脏疾病（终末期肾病或 eGFR 减半的综合）和死亡率。
结果
与控制血压相比，隐匿性未控制高血压的存在与心血管结局和肾脏结局的风险增加独立相关，但与全因死亡率无关。较高的平均 24 小时收缩压与心血管结局、肾脏结局和死亡率的风险增加独立相关，与诊室血压无关。日间血压变化的反向杓型患者发生肾脏结局的风险较高。
结论
在该 CKD 患者队列中，源自动态血压监测的血压指标与心血管结局、肾脏结局和死亡率独立相关，与诊室血压无关。隐匿性未控制高血压和平均 24 小时血压与心血管疾病和肾脏疾病进展的高风险相关。血压昼夜变化的改变与肾脏疾病、中风和外周动脉疾病进展的高风险相关。这些数据支持更广泛地在评估 CKD 患者的高血压中使用动态血压监测。
播客
本文包含一个播客，网址为 https://www.asn-online.org/media/podcast/JASN/2020_09_24_JASN2020030236.mp3。
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