Flack J M, Neaton J D, Daniels B, Esunge P
Division of General Medicine, School of Medicine, University of Minnesota, Minneapolis.
Am J Kidney Dis. 1993 Apr;21(4 Suppl 1):31-40. doi: 10.1016/s0272-6386(12)80859-6.
Hypertension, particularly severe hypertension, has proven to be a risk factor for renal disease. Whether the relationship of blood pressure (BP) and high renal disease exists across a wide range of BP levels has been less clear. Compared with whites, blacks have a higher rate of end-stage renal disease from a multiplicity of causes, including hypertension, most prominently in younger age groups. To examine ethnic patterns of renal disease across BPs spanning the range of "normal" to "elevated," data were summarized from three large studies: (1) 12-year mortality for the 347,978 men (22,471 black and 325,507 white) without prior myocardia infarction (MI) screened for the Multiple Risk Factor Intervention Trial (MRFIT) who have been followed an average of 12 years for cause-specific mortality, (2) the baseline and 6-year change in renal function in 5,524 hypertensive men (463 black and 5,061 white) randomized in the MRFIT, and (3) the baseline and 1-year change in creatinine level are compared in 902 black and white men and women (177 black and 725 white) with mild hypertension in the Treatment of Mild Hypertension Study (TOMHS). In the MRFIT screenees, there was a monotonic increase in the risk of renal mortality at higher BP levels, even within the "normal range," both in black and white men. Blacks had higher baseline creatinine levels in both the MRFIT and TOMHS. In the MRFIT hypertensive patients, 6-year change in creatinine predicts coronary heart disease and all-cause mortality while the baseline creatinine level did not. Comparisons of randomized groups in the MRFIT or TOMHS did not demonstrate improved renal function with more aggressive BP lowering, but in MRFIT average on-treatment DBP < 95 mm Hg was associated with more favorable slopes of reciprocal creatinine. At 1 year, no gender-specific ethnic differences in creatinine change were observed in TOMHS. In the MRFIT hypertensive men, 6-year creatinine change was slightly more favorable in white men than in black men (-0.088 mumol/l v +3.09 mumol/L, P = 0.004). These data demonstrate (1) a graded and continuous relationship between BP and renal disease in blacks and whites across a wide BP range, (2) that creatinine change predicts subsequent mortality, at least in hypertensive men treated with diuretic-based pharmacologic regimen, and (3) possibly different pattern of creatinine change in response to antihypertensive drug therapy in blacks and whites.
高血压，尤其是重度高血压，已被证明是肾病的一个危险因素。血压（BP）与高肾病发生率之间在广泛的血压水平范围内是否存在关联尚不太明确。与白人相比，黑人因多种原因导致的终末期肾病发生率更高，这些原因包括高血压，在较年轻年龄组中最为显著。为了研究在从“正常”到“升高”的整个血压范围内肾病的种族模式，我们汇总了三项大型研究的数据：（1）多重危险因素干预试验（MRFIT）中筛查出的347,978名无既往心肌梗死（MI）的男性（22,471名黑人，325,507名白人）的12年死亡率，这些男性平均随访了12年以了解特定病因死亡率；（2）MRFIT中随机分组的5,524名高血压男性（463名黑人，5,061名白人）的肾功能基线及6年变化情况；（3）轻度高血压治疗研究（TOMHS）中902名黑人和白人男性及女性（177名黑人，725名白人）的肌酐水平基线及1年变化情况。在MRFIT筛查对象中，无论黑人还是白人男性，即使在“正常范围”内，较高血压水平下肾病死亡风险也呈单调增加。在MRFIT和TOMHS中，黑人的肌酐基线水平都更高。在MRFIT高血压患者中，肌酐的6年变化可预测冠心病和全因死亡率，而肌酐基线水平则不能。MRFIT或TOMHS中随机分组的比较未显示更积极的血压降低能改善肾功能，但在MRFIT中，治疗期间平均舒张压<95 mmHg与肌酐倒数的更有利斜率相关。在TOMHS中，1年时未观察到肌酐变化存在性别特异性的种族差异。在MRFIT高血压男性中，白人男性的6年肌酐变化略优于黑人男性（-0.088 μmol/L对+3.09 μmol/L，P = 0.004）。这些数据表明：（1）在广泛的血压范围内，黑人和白人的血压与肾病之间存在分级且连续的关系；（2）肌酐变化可预测随后的死亡率，至少在接受基于利尿剂的药物治疗方案的高血压男性中如此；（3）黑人和白人对抗高血压药物治疗的肌酐变化模式可能不同。
