Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
J Clin Hypertens (Greenwich). 2024 Feb;26(2):207-216. doi: 10.1111/jch.14776. Epub 2024 Jan 31.
The study aims to assess the relationship between cumulative blood pressure load (cBPL) and the risk of renal function decline in hypertensive patients and determine the blood pressure (BP) threshold required to prevent hypertensive nephropathy. A single-center prospective cohort study was conducted on hypertensive patients. The cBPL was defined as the proportion of area beyond variable BP cutoffs under ambulatory BP monitoring. Renal events were defined as > 25% (minor) or > 50% (major) decline of baseline estimated glomerular filtration rate (eGFR). Cox regression analysis was conducted between cBPL, other ambulatory BP parameters, and renal events. The results revealed a total of 436 Han Chinese hypertensive patients were eligible for enrollment. During an average follow-up period of 5.1 ± 3.3 years, a decline of > 25% and > 50% in eGFR was observed in 77 and eight participants, respectively. Cox regression analysis revealed that cSBPL140 (hazard ratio [HR], 1.102; 95% confidence interval [CI], 1.017-1.193; p = .017), cSBPL130 (HR, 1.076; 95% CI, 1.019-1.137; p = .008), and cSBPL120 (HR, 1.054; 95% CI, 1.010-1.099; p = .015) were independently associated with minor renal events. Similarly, cSBPL140 (HR, 1.228; 95% CI, 1.037-1.455; p = .017), cSBPL130 (HR, 1.189; 95% CI, 1.045-1.354; p = .009), and cSBPL120 (HR, 1.155; 95% CI, 1.039-1.285; p = .008) were independently associated with major renal events. In conclusion, cBPL is associated with renal function decline in hypertensive patients. Minimizing cBPL120 may decrease the risk of hypertensive nephropathy.
这项研究旨在评估累积血压负荷（cBPL）与高血压患者肾功能下降风险之间的关系，并确定预防高血压肾病所需的血压（BP）阈值。一项单中心前瞻性队列研究纳入了高血压患者。cBPL 定义为动态血压监测下可变 BP 切点以外的面积比例。肾脏事件定义为基础估计肾小球滤过率（eGFR）下降>25%（轻度）或>50%（重度）。Cox 回归分析了 cBPL、其他动态血压参数与肾脏事件之间的关系。结果显示，共有 436 名汉族高血压患者符合入组条件。在平均 5.1±3.3 年的随访期间，77 名和 8 名参与者的 eGFR 分别下降>25%和>50%。Cox 回归分析显示，cSBPL140（风险比[HR]，1.102；95%置信区间[CI]，1.017-1.193；p=0.017）、cSBPL130（HR，1.076；95%CI，1.019-1.137；p=0.008）和 cSBPL120（HR，1.054；95%CI，1.010-1.099；p=0.015）与轻度肾脏事件独立相关。同样，cSBPL140（HR，1.228；95%CI，1.037-1.455；p=0.017）、cSBPL130（HR，1.189；95%CI，1.045-1.354；p=0.009）和 cSBPL120（HR，1.155；95%CI，1.039-1.285；p=0.008）与重度肾脏事件独立相关。结论：cBPL 与高血压患者的肾功能下降有关。最大限度地降低 cBPL120 可能会降低高血压肾病的风险。
