Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea.
Department of Internal Medicine National Health Insurance Service Medical CenterIlsan Hospital Goyangshi Republic of Korea.
J Am Heart Assoc. 2022 Jun 7;11(11):e025513. doi: 10.1161/JAHA.122.025513. Epub 2022 Jun 3.
Background Whether visit-to-visit systolic blood pressure (SBP) variability can predict major adverse cardiovascular events (MACE) in patients with chronic kidney disease is unclear. Methods and Results We investigated the relationship between SDs of visit-to-visit SBP variability during the first year of enrollment and MACE among 1575 participants from KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into 3 groups according to tertiles of visit-to-visit SBP variability (SD). The study end point was MACE, defined as a composite of nonfatal myocardial infarction, unstable angina, revascularization, nonfatal stroke, hospitalization for heart failure, or cardiac death. During 6748 patient-years of follow-up (median, 4.2 years), MACE occurred in 64 participants (4.1%). Compared with the lowest tertile of visit-to-visit SBP variability (SD), the hazard ratios (HRs) for the middle and the highest tertile were 1.64 (95% CI, 0.80-3.36) and 2.23 (95% CI, 1.12-4.44), respectively, in a multivariable cause-specific hazard model. In addition, the HR associated with each 5-mm Hg increase in visit-to-visit SBP variability (SD) was 1.21 (95% CI, 1.01-1.45). This association was consistent in sensitivity analyses with 2 additional definitions of SBP variability determined by the coefficient of variation and variation independent of the mean. The corresponding HRs for the middle and highest tertiles were 2.11 (95% CI, 1.03-4.35) and 2.28 (95% CI, 1.12-4.63), respectively, in the analysis with the coefficient of variation and 1.76 (95% CI, 0.87-3.57) and 2.04 (95% CI, 1.03-4.03), respectively, with the variation independent of the mean. Conclusions Higher visit-to-visit SBP variability is associated with an increased risk of MACE in patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.
在慢性肾脏病患者中，血压变异性的随访收缩压（SBP）是否可以预测主要不良心血管事件（MACE）尚不清楚。
我们研究了 1575 名 KNOW-CKD（韩国慢性肾脏病患者结局研究）参与者在入组后第一年的随访收缩压变异性（SD）的 SD 与 MACE 之间的关系。参与者根据随访收缩压变异性的三分位数（SD）分为 3 组。研究终点为 MACE，定义为非致死性心肌梗死、不稳定型心绞痛、血运重建、非致死性卒中、心力衰竭住院或心脏死亡的复合终点。在 6748 患者年的随访（中位随访时间 4.2 年）期间，64 名患者发生 MACE（4.1%）。与最低三分位数的随访收缩压变异性（SD）相比，中三分位数和最高三分位数的 HR 分别为 1.64（95%CI，0.80-3.36）和 2.23（95%CI，1.12-4.44），在多变量病因特异性风险模型中。此外，与随访收缩压变异性（SD）每增加 5mmHg 相关的 HR 为 1.21（95%CI，1.01-1.45）。当使用变异系数和独立于均值的变异两种方法来确定 SBP 变异性的另外两种定义时，这种相关性在敏感性分析中仍然一致。在使用变异系数的分析中，中三分位数和最高三分位数的相应 HR 分别为 2.11（95%CI，1.03-4.35）和 2.28（95%CI，1.12-4.63），在使用独立于均值的变异的分析中，相应的 HR 分别为 1.76（95%CI，0.87-3.57）和 2.04（95%CI，1.03-4.03）。
在慢性肾脏病患者中，较高的随访收缩压变异性与 MACE 风险增加相关。
