Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease.
Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease.
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DOI：
10.1097/hjh.0000000000000779
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发表时间：
2016-02
影响因子：
4.9
通讯作者：
Go AS
中科院分区：
文献类型：
--
作者：
Chang TI;Tabada GH;Yang J;Tan TC;Go AS
血压的访视间变异性是过早死亡和心血管事件的重要独立风险因素，但对尚未接受透析的慢性肾脏疾病患者的这种现象知之甚少。我们对114，900名患有3-4期慢性肾脏疾病的成年人（估计肾小球滤过率为15-59 mL/min/1.73 m2）进行了一项基于社区的回顾性研究。我们假设血压的访视间变异性与死亡、终末期肾病和心血管事件的高风险独立相关。我们使用三个指标定义收缩期访视间血压变异性：（1）变异系数;（2）平均收缩压的标准差;（3）平均真实的变异性。变异系数的最高和最低五分位数与较高的校正死亡率（风险比1.22; 95%置信区间1.11-1.34）和出血性卒中（风险比1.91，置信区间1.36-2.68）相关。访视间血压变异性与心力衰竭的相关性不一致，与急性冠脉综合征和缺血性卒中的相关性不显著。当使用其他两种访视间血压变异性时，结果相似。访视间血压变异性与终末期肾病的相关性不一致，可能是由于该结局的发生率相对较低。在尚未接受透析的中晚期慢性肾脏病患者中，较高的访视间血压变异性与较高的死亡率和出血性卒中发生率独立相关。
Visit-to-visit variability of blood pressure is an important independent risk factor for premature death and cardiovascular events, but relatively little is known about this phenomenon in patients with chronic kidney disease not yet on dialysis. We conducted a retrospective study in a community-based cohort of 114,900 adults with chronic kidney disease stages 3–4 (estimated glomerular filtration rate 15–59 mL/min per 1.73 m2). We hypothesized that visit-to-visit variability of blood pressure would be independently associated with higher risks of death, incident treated end-stage renal disease, and cardiovascular events. We defined systolic visit-to-visit variability of blood pressure using three metrics: (1) coefficient of variation (2) standard deviation of the mean systolic blood pressure, and (3) average real variability. The highest versus the lowest quintile of the coefficient of variation was associated with higher adjusted rates of death (hazard ratio 1.22; 95% confidence interval 1.11–1.34) and hemorrhagic stroke (hazard ratio 1.91, confidence interval 1.36–2.68). Visit-to-visit variability of blood pressure was inconsistently associated with heart failure, and was not significantly associated with acute coronary syndrome and ischemic stroke. Results were similar when using the other two visit-to-visit variability of blood pressure. Visit-to-visit variability of blood pressure had inconsistent associations with end-stage renal disease, perhaps due to the relatively low incidences of this outcome. Higher visit-to-visit variability of blood pressure is independently associated with higher rates of death and hemorrhagic stroke in patients with moderate to advanced chronic kidney disease not yet on dialysis.