在接受稳定肾脏科护理的 CKD 患者中，动态血压控制的性别差异与 ESKD 和死亡风险相关。
Sex difference in ambulatory blood pressure control associates with risk of ESKD and death in CKD patients receiving stable nephrology care.
机构信息
Division of Nephrology, University of Campania, Luigi Vanvitelli, Naples, Italy.
Department of Medicine, VA San Diego Healthcare System-University of California at San Diego Medical School, San Diego, CA, USA.
出版信息
Nephrol Dial Transplant. 2021 Nov 9;36(11):2000-2007. doi: 10.1093/ndt/gfab017.
BACKGROUND
It is unknown whether faster progression of chronic kidney disease (CKD) in men than in women relates to differences in ambulatory blood pressure (ABP) levels.
METHODS
We prospectively evaluated 906 hypertensive CKD patients (553 men) regularly followed in renal clinics to compare men versus women in terms of ABP control [daytime <135/85 and nighttime blood pressure (BP) <120/70 mmHg] and risk of all-cause mortality and end-stage kidney disease (ESKD).
RESULTS
Age, estimated glomerular filtration rate and use of renin-angiotensin system inhibitors were similar in men and women, while proteinuria was lower in women [0.30 g/24 h interquartile range (IQR) 0.10-1.00 versus 0.42 g/24 h, IQR 0.10-1.28, P = 0.025]. No sex-difference was detected in office BP levels; conversely, daytime and nighttime BP were higher in men (134 ± 17/78 ± 11 and 127 ± 19/70 ± 11 mmHg) than in women (131 ± 16/75 ± 11, P = 0.005/P < 0.001 and 123 ± 20/67 ± 12, P = 0.006/P < 0.001), with ABP goal achieved more frequently in women (39.1% versus 25.1%, P < 0.001). During a median follow-up of 10.7 years, 275 patients reached ESKD (60.7% men) and 245 died (62.4% men). Risks of ESKD and mortality (hazard ratio and 95% confidence interval), adjusted for demographic and clinical variables, were higher in men (1.34, 1.02-1.76 and 1.36, 1.02-1.83, respectively). Adjustment for office BP at goal did not modify this association. In contrast, adjustment for ABP at goal attenuated the increased risk in men for ESKD (1.29, 0.98-1.70) and death (1.31, 0.98-1.77). In the fully adjusted model, ABP at goal was associated with reduced risk of ESKD (0.49, 0.34-0.70) and death (0.59, 0.43-0.80). No interaction between sex and ABP at goal on the risk of ESKD and death was found, suggesting that ABP-driven risks are consistent in males and females.
CONCLUSIONS
Our study highlights that higher ABP significantly contributes to higher risks of ESKD and mortality in men.
背景
目前尚不清楚男性慢性肾脏病（CKD）进展较快是否与动态血压（ABP）水平的差异有关。
方法
我们前瞻性评估了 906 例定期在肾脏科就诊的高血压 CKD 患者（553 例男性），比较了男性和女性之间的 ABP 控制[白天<135/85mmHg 和夜间血压（BP）<120/70mmHg]和全因死亡率及终末期肾病（ESKD）的风险。
结果
男性和女性的年龄、估计肾小球滤过率和肾素-血管紧张素系统抑制剂的使用情况相似，而女性的蛋白尿水平较低[24 小时尿蛋白 0.30g（四分位距 0.10-1.00）比 0.42g（四分位距 0.10-1.28），P=0.025]。诊室 BP 水平无性别差异；相反，男性的日间和夜间 BP 较高（134±17/78±11 和 127±19/70±11mmHg），而女性则较低（131±16/75±11，P=0.005/ P<0.001 和 123±20/67±12，P=0.006/ P<0.001），女性 ABP 目标达标更为频繁（39.1%比 25.1%，P<0.001）。中位随访 10.7 年后，275 例患者达到 ESKD（60.7%为男性），245 例患者死亡（62.4%为男性）。在校正人口统计学和临床变量后，男性的 ESKD 和死亡率（风险比和 95%置信区间）更高（1.34，1.02-1.76 和 1.36，1.02-1.83）。调整目标办公室 BP 并不能改变这种关联。相反，调整目标 ABP 可降低男性发生 ESKD（1.29，0.98-1.70）和死亡（1.31，0.98-1.77）的风险。在完全调整模型中，目标 ABP 与 ESKD（0.49，0.34-0.70）和死亡（0.59，0.43-0.80）风险降低相关。未发现性别和目标 ABP 对 ESKD 和死亡风险之间存在交互作用，提示 ABP 驱动的风险在男性和女性中是一致的。
结论
本研究强调，较高的 ABP 显著增加了男性发生 ESKD 和死亡的风险。
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