Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
Am J Hypertens. 2024 Jun 14;37(7):455-464. doi: 10.1093/ajh/hpae029.
Chronic kidney disease (CKD) is associated with accelerated vascular calcification and increased central systolic blood pressure when measured invasively (invCSBP) relative to cuff-based brachial systolic blood pressure (cuffSBP). The contribution of aortic wall calcification to this phenomenon has not been clarified. We, therefore, examined the effects of aortic calcification on cuffSBP and invCSBP in a cohort of patients representing all stages of CKD.
During elective coronary angiography, invCSBP was measured in the ascending aorta with a fluid-filled catheter with simultaneous recording of cuffSBP using an oscillometric device. Furthermore, participants underwent a non-contrast computed tomography scan of the entire aorta with observer-blinded calcification scoring of the aortic wall ad modum Agatston.
We included 168 patients (mean age 67.0 ± 10.5, 38 females) of whom 38 had normal kidney function, while 30, 40, 28, and 32 had CKD stages 3a, 3b, 4, and 5, respectively. Agatston scores adjusted for body surface area ranged from 48 to 40,165. We found that invCSBP increased 3.6 (95% confidence interval 1.4-5.7) mm Hg relative to cuffSBP for every 10,000-increment in aortic Agatston score. This association remained significant after adjustment for age, diabetes, antihypertensive treatment, smoking, eGFR, and BP level. No such association was found for diastolic BP.
Patients with advanced aortic calcification have relatively higher invCSBP for the same cuffSBP as compared to patients with less calcification. Advanced aortic calcification in CKD may therefore result in hidden central hypertension despite apparently well-controlled cuffSBP. ClinicalTrials.gov identifier: NCT04114695.
与基于袖带的肱动脉收缩压（cuffSBP）相比，慢性肾脏病（CKD）患者的血管钙化加速，中心收缩压升高，当采用有创方法（invCSBP）测量时。主动脉壁钙化对此现象的影响尚未阐明。因此，我们在代表 CKD 所有阶段的患者队列中检查了主动脉钙化对 cuffSBP 和 invCSBP 的影响。
在选择性冠状动脉造影期间，使用充满液体的导管在升主动脉中测量 invCSBP，并使用振荡设备同时记录 cuffSBP。此外，参与者接受了整个主动脉的非对比计算机断层扫描，并使用 Agatston 方法对主动脉壁进行观察者盲法钙化评分。
我们纳入了 168 名患者（平均年龄 67.0±10.5 岁，38 名女性），其中 38 名患者肾功能正常，而 30、40、28 和 32 名患者分别患有 CKD 3a、3b、4 和 5 期。校正体表面积的 Agatston 评分范围从 48 到 40165。我们发现，主动脉 Agatston 评分每增加 10000 个单位，invCSBP 相对于 cuffSBP 增加 3.6（95%置信区间 1.4-5.7）mmHg。这种关联在调整年龄、糖尿病、降压治疗、吸烟、eGFR 和 BP 水平后仍然显著。对于舒张压，没有发现这种关联。
与钙化程度较低的患者相比，主动脉钙化程度较高的患者具有相对较高的 invCSBP ，而 cuffSBP 相同。因此，尽管 cuffSBP 似乎得到了很好的控制，但 CKD 中的主动脉严重钙化可能导致隐匿性中心高血压。临床试验注册号：NCT04114695。
