2021年改善全球肾脏病预后组织（KDIGO）成人慢性肾脏病血压指南对心血管的影响

Cardiovascular Implications of the 2021 KDIGO Blood Pressure Guideline for Adults With Chronic Kidney Disease.

作者信息

Lee Hyeok-Hee, Lee Hokyou, Townsend Raymond R, Kim Dong-Wook, Park Sungha, Kim Hyeon Chang

机构信息

Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea; Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

出版信息

J Am Coll Cardiol. 2022 May 3;79(17):1675-1686. doi: 10.1016/j.jacc.2022.02.040.

DOI:10.1016/j.jacc.2022.02.040

PMID:35483755

Abstract

BACKGROUND

The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommends a systolic blood pressure (BP) target of <120 mm Hg for nondialysis chronic kidney disease (CKD).

OBJECTIVES

We sought to examine the potential implications of the 2021 KDIGO BP target, compared with the 2012 KDIGO and 2017 American College of Cardiology (ACC)/American Heart Association (AHA) BP targets, as related to cardiovascular disease (CVD) outcomes.

METHODS

From the cross-sectional Korea National Health and Nutrition Examination Survey (KNHANES) and longitudinal National Health Insurance Service (NHIS) data, adults with nondialysis CKD were identified and categorized into 4 groups based on concordance/discordance between guidelines: 1) above both targets; 2) above 2021 KDIGO only; 3) above 2012 KDIGO or 2017 ACC/AHA only; and 4) controlled within both targets. We determined the nationally representative proportion and CVD risk of each group.

RESULTS

In KNHANES (n = 1,939), 50.2% had BP above both 2021 and 2012 KDIGO targets, 15.9% above the 2021 KDIGO target only, 3.5% above the 2012 KDIGO target only, and 30.4% controlled within both targets. In NHIS (n = 412,167; median follow-up: 10.0 years), multivariable-adjusted HRs for CVD events were 1.52 (95% CI: 1.47-1.58) among participants with BP above both targets, 1.28 (95% CI: 1.24-1.32) among those with BP above 2021 KDIGO only, and 1.07 (95% CI: 0.61-1.89) among those with BP above 2012 KDIGO only, compared to those with BP controlled within both targets. Results were similar for comparison between 2021 KDIGO and 2017 ACC/AHA BP targets.

CONCLUSIONS

New candidates for BP-lowering treatment per the 2021 KDIGO guideline account for a substantial proportion of the total CKD population and bear significantly high CVD risk.

摘要

背景

《2021年改善全球肾脏病预后（KDIGO）指南》推荐非透析慢性肾脏病（CKD）的收缩压（BP）目标为<120 mmHg。

目的

我们试图研究与2012年KDIGO和2017年美国心脏病学会（ACC）/美国心脏协会（AHA）的血压目标相比，2021年KDIGO血压目标对心血管疾病（CVD）结局的潜在影响。

方法

从横断面的韩国国民健康与营养检查调查（KNHANES）和纵向的国民健康保险服务（NHIS）数据中，识别出非透析CKD成人，并根据指南之间的一致性/不一致性将其分为4组：1）高于两个目标；2）仅高于2021年KDIGO目标；3）仅高于2012年KDIGO或2017年ACC/AHA目标；4）在两个目标范围内得到控制。我们确定了每组具有全国代表性的比例和CVD风险。

结果

在KNHANES（n = 1939）中，50.2%的人的血压高于2021年和2012年KDIGO目标，15.9%的人仅高于2021年KDIGO目标，3.5%的人仅高于2012年KDIGO目标，30.4%的人在两个目标范围内得到控制。在NHIS（n = 412167；中位随访时间：10.0年）中，与血压在两个目标范围内得到控制的参与者相比，血压高于两个目标的参与者发生CVD事件的多变量调整后HR为1.52（95%CI：1.47 - 1.58），仅高于2021年KDIGO目标的参与者为1.28（95%CI：1.24 - 1.32），仅高于2012年KDIGO目标的参与者为1.07（95%CI：0.61 - 1.89）。2021年KDIGO与2017年ACC/AHA血压目标之间的比较结果相似。