Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08308, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Sci Rep. 2021 Jan 15;11(1):1538. doi: 10.1038/s41598-021-81328-y.
The effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged ≥ 40 years) with CKD and without previous cardiovascular disease or ESRD (n = 22,278). The SBP and DBP were ≥ 130 mmHg and ≥ 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP ≥ 130 mmHg and DBP ≥ 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120-129 mmHg and DBP 70-79 mmHg). SBP < 100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be < 130/80 mmHg and the SBP should not be < 100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.
本研究使用韩国国家健康保险服务-健康筛查队列数据，评估了伴有或不伴有降压治疗的慢性肾脏病（CKD）患者的血压（BP）对心血管事件、进展至终末期肾病（ESRD）和死亡率的影响。该研究纳入了无先前心血管疾病或 ESRD 的年龄≥40 岁的 CKD 成年人（n=22278），根据收缩压（SBP）或舒张压（DBP）分析了结局的风险。10809 名（48.52%）和 11583 名（51.99%）参与者的 SBP 和 DBP 分别≥130mmHg 和≥80mmHg。在中位 6.2 年的随访期间，发生了 1271 例心血管事件、201 例 ESRD 事件和 1061 例死亡。与参考值（SBP 120-129mmHg 和 DBP 70-79mmHg）相比，SBP≥130mmHg 和 DBP≥80mmHg 的患者发生高血压相关不良结局的风险更高。SBP<100mmHg 与全因死亡风险以及随访期间 ESRD 和全因死亡的复合结局风险相关，但仅在降压药物使用者中相关，这表明降压治疗应使血压<130/80mmHg，且 SBP 不应<100mmHg，以预防 CKD 患者降压治疗不足和过度的不良结局风险。
