Both chronic kidney disease and nocturnal blood pressure associate with strokes in the elderly.
Both chronic kidney disease and nocturnal blood pressure associate with strokes in the elderly.
复制标题
慢性肾脏病和夜间血压都与老年人中风有关。
DOI：
10.1159/000354232
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Kario K.
中科院分区：
文献类型：
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作者：
Yano Y;Bakris GL;Matsushita K;Hoshide S;Shimada K;Kario K.
背景：在老年高血压患者中，我们旨在评估夜间血压（BP）模式与卒中的相关性;探讨了倾斜模式与肾脏疾病的相互作用。方法：我们回顾性分析了1，276例日本老年（≥60岁）高血压患者（平均年龄74岁; 40%为男性）的记录，这些患者测量了估计的肾小球滤过率和动态BP。结果：73例患者在平均3.2年（4，026人-年）内发生卒中事件。基线时慢性肾脏病（CKD）（n = 634，50%）在中风患者中（71%）比非中风患者（48%; p < 0.01）更普遍。CKD和夜间收缩压（SBP）升高（10 mmHg）均与卒中风险增加独立相关[CKD的风险比（HR）为1.9; 95%置信区间（CI）为1.1-3.1，SBP的HR为1.2; 1.1-1.4]。校正诊室SBP后，CKD患者（HR 1.2; 95% CI 1.0-1.3）和非CKD患者（HR 1.2; 95% CI 0.97-1.5）夜间SBP升高10 mmHg与卒中的相关性相似。虽然反向下降（夜间收缩压≥白天收缩压）仅在CKD患者中与脑卒中相关（HR 2.1; 95%CI 1.1-4.1），而在无CKD患者中与脑卒中无关（HR 1.1; 95%CI 0.3-3.8），但相互作用不显著（p = 0.30）。
Background:Among elderly hypertensive patients, we aimed to assess the association of nocturnal blood pressure (BP) pattern on stroke; interaction of dipping pattern with kidney disease was explored.Methods:We retrospectively analyzed the records of 1,276 elderly (≥60 years) hypertensive Japanese patients (mean 74 years; 40% were men) who had measurements of estimated glomerular filtration rate and ambulatory BP.Results:Stroke events occurred in 73 people over an average of 3.2 years (4,026 person-years). Chronic kidney disease (CKD) at baseline (n = 634, 50%) was more prevalent in people with strokes (71%) than those without strokes (48%; p < 0.01). Both CKD and nocturnal systolic BP (SBP) increase (10 mm Hg) were independently associated with increased risk for stroke [hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.1-3.1 for CKD and HR 1.2; 1.1-1.4 for SBP]. After adjustment for office SBP, a 10-mm Hg increase in nocturnal SBP was similarly associated with strokes in patients with CKD (HR 1.2; 95% CI 1.0-1.3) and those without CKD (HR 1.2; 95% CI 0.97-1.5). Although reverse dipping (nocturnal SBP ≥ daytime SBP) was associated with stroke only in patients with CKD (HR 2.1; 95% CI 1.1-4.1) and not those without CKD (HR 1.1; 95% CI 0.3-3.8), the interaction effect was not significant (p = 0.30).Conclusion:In elderly hypertensive patients, both high nocturnal SBP and CKD are independent risk factors for stroke.