Institute for Translational Medicine and Therapeutics (ITMAT), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
Renal-Electrolyte and Hypertension Division, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
J Hum Hypertens. 2024 May;38(5):420-429. doi: 10.1038/s41371-023-00884-0. Epub 2024 Jan 11.
Chronic kidney disease (CKD) represents a significant global burden. Hypertension is a modifiable risk factor for rapid progression of CKD. We extend the risk stratification by introducing the non-parametric determination of rhythmic components in 24-h profiles of ambulatory blood pressure monitoring (ABPM) in the Chronic Renal Insufficiency Cohort (CRIC) and the African American Study for Kidney Disease and Hypertension (AASK) cohort using Cox proportional hazards models. We find that rhythmic profiling of BP through JTK_CYCLE analysis identifies subgroups of CRIC participants that were more likely to die due to cardiovascular causes. While our fully adjusted model shows a trend towards a significant association between absent cyclic components and cardiovascular death in the full CRIC cohort (HR: 1.71,95% CI: 0.99-2.97, p = 0.056), CRIC participants with a history of cardiovascular disease (CVD) and absent cyclic components in their BP profile had at any time a 3.4-times higher risk of cardiovascular death than CVD patients with cyclic components present in their BP profile (HR: 3.37, 95% CI: 1.45-7.87, p = 0.005). This increased risk was not explained by the dipping or non-dipping pattern in ABPM. Due to the large differences in patient characteristics, the results do not replicate in the AASK cohort. This study suggests rhythmic blood pressure components as a potential novel biomarker to unmask excess risk among CKD patients with prior cardiovascular disease.
慢性肾脏病（CKD）是一个全球性的重大负担。高血压是 CKD 快速进展的一个可改变的危险因素。我们通过 Cox 比例风险模型，在慢性肾功能不全队列（CRIC）和非裔美国人肾脏病和高血压研究（AASK）队列中，引入了非参数确定 24 小时动态血压监测（ABPM）的节律成分，从而扩展了风险分层。我们发现，通过 JTK_CYCLE 分析对 BP 进行节律分析，可以确定 CRIC 参与者中更有可能因心血管原因死亡的亚组。虽然我们的完全调整模型显示，在完全 CRIC 队列中，无循环成分与心血管死亡之间存在显著关联的趋势（HR：1.71，95%CI：0.99-2.97，p=0.056），但在 CRIC 参与者中，有心血管病史和 BP 特征无循环成分的参与者，其心血管死亡风险任何时候都比 BP 特征中有循环成分的 CVD 患者高 3.4 倍（HR：3.37，95%CI：1.45-7.87，p=0.005）。ABPM 中的夜间下降或非夜间下降模式并不能解释这种增加的风险。由于患者特征存在较大差异，因此这些结果在 AASK 队列中并未得到复制。本研究表明，节律性血压成分可能是一种潜在的新型生物标志物，可以揭示有既往心血管疾病的 CKD 患者的额外风险。
