Clinic of Nephrology, Dialysis and Transplant IRCCS Ospedale Policlinico San Martino Genoa Italy.
Department of Internal Medicine and Medical Specialties University of Genoa Genoa Italy.
J Am Heart Assoc. 2024 Aug 6;13(15):e034108. doi: 10.1161/JAHA.124.034108. Epub 2024 Jul 16.
The predictive role of blood pressure variability for all-cause mortality and fatal and nonfatal cardiovascular events has been described in the general population and in patients with diabetes, independently of mean BP. Although systolic blood pressure variability has been proposed as an informative measure for predicting clinical outcomes in patients with chronic kidney disease, its role in kidney transplant recipients is still debatable.
We performed a retrospective, observational, monocentric analysis of all kidney transplant recipients in follow-up at the outpatient Nephrology Clinic of San Martino Hospital from January 1, 2016 to December 31, 2016, who underwent kidney transplantation >12 months. The primary outcome was a fatal or nonfatal cardiovascular event (myocardial infarction, unstable angina, stroke, and hospitalization for heart failure). Visit-to-visit systolic blood pressure variability was expressed as the SD of systolic blood pressure values recorded at baseline and 3 months up to 18 months. Among the 272 patients (mean age, 64±13; 63% men) included in the present analyses, for each increase of 2.7 mm Hg in systolic blood pressure SD, the risk for events increased 3-fold (hazard ratio [HR], 3.1 [95% CI, 1.19-7.88]; =0.02), and patients in the highest tertile of systolic blood pressure SD showed a 4-fold increased risk (HR, 4.1 [95% CI, 1.34-12.43]; =0.01). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, and prior cardiovascular event (HR, 3.2 [95% CI, 1.1-10.0]; =0.04).
Long-term blood pressure variability represents a risk factor for cardiovascular events in kidney transplant recipients, even independently by several confounding factors including blood pressure load.
血压变异性对全因死亡率和致命及非致命心血管事件的预测作用已在一般人群和糖尿病患者中得到描述，独立于平均血压。虽然收缩压变异性已被提出作为预测慢性肾脏病患者临床结局的有用指标，但在肾移植受者中的作用仍存在争议。
我们对 2016 年 1 月 1 日至 2016 年 12 月 31 日期间在圣马蒂诺医院门诊肾脏病诊所接受随访的所有肾移植受者进行了回顾性、观察性、单中心分析，这些受者的肾移植时间超过 12 个月。主要结局是致命或非致命心血管事件（心肌梗死、不稳定型心绞痛、卒中和心力衰竭住院）。随访收缩压变异性用基线和 3 个月至 18 个月时记录的收缩压值的标准差表示。在本分析中包括的 272 例患者（平均年龄 64±13 岁；63%为男性）中，收缩压 SD 每增加 2.7mmHg，事件风险增加 3 倍（风险比[HR]，3.1[95%可信区间，1.19-7.88]；=0.02），收缩压 SD 最高三分位的患者风险增加 4 倍（HR，4.1[95%可信区间，1.34-12.43]；=0.01）。即使在对平均脉压、年龄、糖尿病和既往心血管事件进行增量调整后，这种关系仍然存在（HR，3.2[95%可信区间，1.1-10.0]；=0.04）。
长期血压变异性是肾移植受者心血管事件的危险因素，即使独立于包括血压负荷在内的几个混杂因素也是如此。
