肾功能不全的老年高血压患者收缩压控制水平对肾小球滤过率影响的随访研究-东南大学学报医学版

肾功能不全的老年高血压患者收缩压控制水平对肾小球滤过率影响的随访研究

单位：南京医科大学附属老年病医院, 江苏南京 210024

分类号：R544.1;R692

出版年·卷·期（页码）：2021·40·第三期（318-323）

摘要：

目的：探讨慢性肾脏病（CKD）Ⅱ期的老年高血压患者的收缩压（SBP）控制水平对肾小球滤过率的影响。方法：本研究是以医院为基础的随访观察研究，研究对象为2001年2月14日以来在江苏省老年医院就诊的CKDⅡ期的老年（60岁以上）高血压患者。结局变量为估算肾小球滤过率（eGFR），eGFR<60 ml·min^-1·1.73 m^-2（CKDⅢ期）为结局事件。自变量为研究对象的基线SBP控制水平，分析时将研究对象分为6个组，即S1（SBP<120 mmHg）、S2（120 mmHg≤SBP<130 mmHg）（参照组）、S3（130 mmHg≤SBP<140 mmHg）、S4（140 mmHg≤SBP<150 mmHg）、S5（150 mmHg≤SBP<160 mmHg）和S6（SBP≥160 mmHg）。使用多因素COX回归模型分析SBP控制水平与eGFR之间的关联。结果：本研究共入组381例，完成随访318例，随访率为83.46%。与参照组人群相比，其余各组人群由CKDⅡ期进展为Ⅲ期的风险显著增大，S1、S3、S4、S5、S6组HR值分别为2.67（95%CI：1.22~5.87）、2.78（95%CI：1.39~5.54）、2.49（95%CI：1.22~5.11）、4.02（95%CI：1.96~8.24）、3.59（95%CI：1.75~7.37）。女性相对于男性、年龄≥80岁人群相对于60~79岁人群更易发生肾功能减退。合并症中房颤为肾功能减退的独立危险因素（HR=1.92，95%CI：1.82~3.12，P<0.01）。结论：对于CKDⅡ期老年高血压患者而言，在可耐受的情况下将SBP控制在120~130 mmHg水平有助于延缓肾功能减退。合并房颤的CKDⅡ期老年高血压患者更易进展为CKDⅢ期。

Objective: To investigate the impact of systolic blood pressure (SBP) on estimated glomerular filtration rate (eGFR) among elderly hypertensive patients with chronic kidney diseases(CKD)Ⅱ. Methods: In this longitudinal observational study, a total of 381 elderly hypertensive patients (over 60 years old), with 60 ml·min^-1·1.73 m^-2≤eGFR<90 ml·min^-1·1.73 m^-2, were recruited from Geriatric Hospital of Nanjing Medical University since February 14, 2001. Based on their SBP at baseline, participants were classified into 6 groups: S1(SBP<120 mmHg), S2(120 mmHg≤SBP<130 mmHg), S3(130 mmHg≤SBP<140 mmHg), S4(140 mmHg≤SBP<150 mmHg), S5(150 mmHg≤SBP<160 mmHg) and S6(SBP≥160 mmHg). The outcome event was renal impairment which referred to eGFR<60 ml·min^-1·1.73 m^-2 identified during the follow-up. COX regression models were introduced to compute hazard ratio (HR) and 95% confidence interval (CI) assessing the impact of SBP on eGFR among participants. Results: Among 381 eligible participants enrolled, 318 were followed up, follow-up rate of 83.46%. Participants in S1,S3,S4,S5 and S6 sub-groups were more likely to develop renal impairment compared to the patients with 120 mmHg≤SBP<130 mmHg,HR of each group was 2.67(95%CI:1.22-5.87),2.78(95%CI:1.39-5.54),2.49(95%CI:1.22-5.11),4.02(95%CI:1.96-8.24),3.59(95%CI:1.75-7.37). Among these elderly hypertensive patients, women than men were more likely to experience renal impairment(HR=1.49, 95%CI: 1.08-2.06); participants over 80 years old tended to develop renal impairment (HR=3.48, 95%CI: 2.26-5.35) relative to their counterparts aged 60-79 years old; and patients with atrial fibrillation (HR=1.92, 95%CI: 1.82-3.12) was an independent risk factor for renal impairment. Conclusion: For elderly CKDⅡ hypertensive patients, SBP controlled at 120-130 mmHg might be of help for preventing renal impairment. The elderly CKDⅡ hypertensive patients with atrial fibrillation are more likely to develop CKDⅢ.

参考文献：

[1] CHEN N, HAO C, PENG X, et al. Roxadustat for anemia in patients with kidney disease not receiving dialysis[J]. N Engl J Med, 2019, 381(11):1001-1010.
[2] CHEUNG A K, CHANG T I, CUSHMAN W C, et al. Blood pressure in chronic kidney disease: conclusions from a Kidney Disease:Improving Global Outcomes (KDIGO) Controversies Conference[J]. Kidney Int, 2019, 95(5):1027-1036.
[3] LEVEY A S, BOSCH J P, LEWIS J B, et al. Modification of Dietin Renal Disease Study Group.A more accurate methodto estimate glomerular filtration rate from serum creatinine:a new prediction equation[J]. Ann Intern Med, 1999, 130(6):461-470.
[4] 中国高血压防治指南修订委员会.中国高血压防治指南[J]. 中华高血压杂志, 2000, 8(2):103-112.
[5] 中国高血压防治指南修订委员会.中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1):24-56.
[6] PAJEWSKI N M, BERLOWITZ D R, BRESS A P, et al. Intensive vs standard blood pressure control in adults 80 years or older:a secondary analysis of the systolic blood pressure intervention trial[J]. J Am Geriatr Soc, 2020, 68(3):496-504.
[7] GBD 2019 Risk Favtors Collaborators.Gloabal burden of 87 risk factors in 204 countries and territories, 1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258):1223-1249.
[8] BRUNO R M, FAGGIONI F, SIMONE D, et al. Arterial stiffness and pulse pressure amplification in adults with isolated systolic hypertension[J]. Artery Research, 2017, 20:72.
[9] LALITA P R, DIANA I, ALEXANDER K.Considerations and controversies in managing chronic kidney disease:an update[J]. Am J Health Syst Pharm, 2017, 74(11):795-810.
[10] GIRNDT M.Diagnosis and treatment of chronic kidney disease[J]. Clin J Am Soc Nephrol, 2017, 58(3):243-256.
[11] CHAND D H, VALENTINI R P.Chronic kidney disease:treatment of comorbidities Ⅱ(hypertension, anemia, and electrolyte management)[J]. Current Treatment Options in Pediatrics, 2019, 5(2):93-101.
[12] KU E, LEE B J, WEI J, et al. Hypertension in CKD:Core Curriculum 2019[J]. Am J Kidney Dis, 2019, 74(1):120-131.
[13] GEORGIANOS P I, AGARWAL R.Resistant hypertension in chronic kidney disease (CKD):prevalence, treatment particularities, and research agenda[J]. Curr Hypertens Rep, 2020, 22(10):e13-e115.
[14] ROBLES N R, FICI F, GRASSI G.J-shaped curve for cardiovascular mortality:systolic or diastolic blood pressure?[J]. Journal of Nephrology, 2019, 32(3):347-353.
[15] RAKUGI H, OGIHARA T, GOTO Y, et al. Comparison of strict-and mild-blood pressure control in elderly hypertensive patients:a per-protocol analysis of JATOS[J]. Hypertens Res, 2010, 33(11):1124-1128.
[16] XIE X, ATKINS E, LV J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes:updated systematic review and meta-analysis[J]. Lancet, 2016, 387(10017):435-443.
[17] KHOURI Y, STEIGERWALT S P, ALSAMARA M, et al. What is the ideal blood pressure goal for patients with stage III or higher chronic kidney disease?[J]. Curr Cardiol Rep, 2011, 13(6):492-501.
[18] CHANG A R, APPEL L J.Target blood pressure for cardiovascular disease prevention in patients with CKD[J]. Clin J Am Soc Nephrol, 2018, 13(10):1572-1574.
[19] 钟方明, 高艳香, 郑金刚.高血压肾损害发病机制的研究进展[J]. 中日友好医院学报, 2015, 29(6):364-366.
[20] MICHIHIRO S, TAKUO H, SHINGO N, et al. Blood pressure and chronic kidney disease stratified by gender and the use of antihypertensive drugs[J]. J Am Heart Assoc, 2020, 9(16):e015592.
[21] CHEN S P, LI C R, CHANG H C, et al. Relationship between metabolic syndrome severity and kidney function as related to gender:a population-based longitudinal study[J]. Clin Nurs Res, 2020, 29(6):355-362.
[22] MANUEL V J, CONXITA J C, JOSÉ S M.Sex hormones and their influence on chronic kidney disease[J]. Curr Opin Nephrol Hypertens, 2019, 28(1):1-9.

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