Cardiovascular and renal protective role of angiotensin blockade in hypertension with advanced CKD: a subgroup analysis of ATTEMPT-CVD randomized trial.
Cardiovascular and renal protective role of angiotensin blockade in hypertension with advanced CKD: a subgroup analysis of ATTEMPT-CVD randomized trial.
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DOI：
10.1038/s41598-018-20874-4
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发表时间：
2018-02-16
影响因子：
4.6
通讯作者：
Matsui K
中科院分区：
文献类型：
--
作者：
Kim-Mitsuyama S;Soejima H;Yasuda O;Node K;Jinnouchi H;Yamamoto E;Sekigami T;Ogawa H;Matsui K
ATTEMPT-CVD研究是前瞻性随机主动对照试验，主要研究结果已报道。根据基线GFR和蛋白尿类别，我们将ATTEMPT-CVD研究的患者分为2个亚组：（1组）eGFR <45 ml/min / 1.73 m2且UACR≥300 mg/g肌酐的患者，定义为G3b和/或A3；（2组）除1组外的患者，定义为其他患者。在G3b和/或A3患者中，ARB组的心血管事件发生率明显低于非ARB组（分别为11 vs 22） （HR = 0.465; 95%CI = 0.224-0.965; P = 0.040）。在G3b和/或A3患者随访期间，ARB组的UACR显著低于非ARB组（P = 0.0003），而eGFR、血浆BNP水平和血压在ARB组和非ARB组之间具有可比性。分配ARB治疗是G3b和/或A3患者心血管事件的重要独立预后因素（P = 0.0268）。另一方面，在其他患者中，ARB组和非ARB组之间心血管事件的发生具有可比性。在晚期CKD患者中，基于arb的治疗可能比非arb治疗在预防心血管事件方面具有更大的益处。
The ATTEMPT-CVD study was prospective randomized active-controlled trial and the main findings had been reported. According to baseline GFR and albuminuria categories, we divided the patients of the ATTEMPT-CVD study into 2 subgroups: (Group 1) the patients with at least one of eGFR of <45 ml/min per 1.73 m2 and UACR of ≥300 mg/g creatinine, defined as G3b and/or A3; (Group 2) the patients except for Group 1, defined as the other patients. In patients with G3b and/or A3, the incidence of cardiovascular events was significantly less in ARB group than in non-ARB group (11 vs 22, respectively) (HR = 0.465: 95%CI = 0.224–0.965; P = 0.040). UACR was significantly less in ARB group than in non-ARB group during follow-up period in patients with G3b and/or A3 (P = 0.0003), while eGFR, plasma BNP levels, and blood pressure were comparable between ARB and non-ARB groups. Allocation to ARB therapy was a significant independent prognostic factor for cardiovascular events in patients with G3b and/or A3 (P = 0.0268). On the other hand, in the other patients, the occurrence of cardiovascular events was comparable between ARB and non-ARB groups. In patients with advanced CKD, ARB-based therapy may confer greater benefit in prevention of cardiovascular events than non-ARB therapy.
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