Cardiovascular outcomes in the African American study of Kidney Disease and Hypertension (AASK) trial
Cardiovascular outcomes in the African American study of Kidney Disease and Hypertension (AASK) trial
复制标题
DOI：
10.1053/j.ajkd.2006.08.004
复制
发表时间：
2006-11-01
影响因子：
13.2
通讯作者：
Lewis, Julia
中科院分区：
文献类型：
--
作者：
Norris, Keith;Bourgoigne, Jacque;Lewis, Julia
背景慢性肾脏疾病患者发生心血管事件的风险增加。方法：我们随机将1,094名患有高血压肾硬化症的非裔美国人(肾小球滤过率为20至65毫升/分钟/1.73米(2)[0.33至1.08毫升/S])分配到初始抗高血压治疗组，用药包括：(1)β-受体阻滞剂美托洛尔；(2)血管紧张素转换酶抑制剂雷米普利；或(3)二氢吡啶钙通道阻滞剂氨氯地平，以及普通血压或低血压治疗目标。使用一项旨在检测肾脏结局差异的设计，我们比较了治疗对心血管事件(心源性死亡、心肌梗死、中风和心力衰竭)在平均4.1年随访期内的影响，并确定了预测心血管结局的基线因素。结果：31名患者死于心血管疾病(0.7%/患者年)，149名患者经历了至少一次心血管疾病结局(3.30/患者年)。总体而言，发生了202次心血管事件(4.5%/患者年)。心血管转换率与随机干预没有显著相关性。在多变量分析中，在控制了年龄、性别、基线GFR和基线蛋白尿组后，7个基线危险因素仍然与心血管综合结果的风险增加独立相关：脉压、高血压病程、异常心电图结果、非高密度脂蛋白胆固醇水平、血清尿素氮水平、尿蛋白-肌酐比、尿钠-钾比、年收入低于15,000美元。结论：无论是随机分组的降压治疗还是血压水平对心血管事件的发生都没有显著影响，这可能是由于功率有限所致。然而，这项分析确定了这一高风险队列中独特的和潜在的可修改的简历风险因素。
Background Patients with chronic kidney disease are at increased risk for cardiovascular (CV) events. Methods: We randomly assigned 1,094 African Americans with hypertensive nephrosclerosis (glomerular filtration rate [GFR], 20 to 65 mL/min/1.73 m(2) [0.33 to 1.08 mL/s]) to initial antihypertensive treatment with either: (1) a beta-blocker, metoprolol; (2) an angiotensin-converting enzyme inhibitor, ramipril; or (3) a dihydropyridine calcium channel blocker, amlodipine, and either a usual- blood pressure (BP) or low-BP treatment goal. Using a design powered to detect renal outcome differences, we compared the effect of treatment on the CV event rate (cardiac death, myocardial infarction, stroke, and heart failure) during a mean follow-up period of 4.1 years and determined baseline factors that predict CV outcomes. Results: Thirty-one patients died of CV disease (0.7%/patient-year), and 149 patients experienced at least 1 CV outcome (3.30/./patient-year). Overall, 202 CV events (4.5%/patient-year) occurred. The CV outcome rate was not related significantly to randomized interventions. In multivariable analyses, 7 baseline risk factors remained independently associated with increased risk for the CV composite outcome after controlling for age, sex, baseline GFR, and baseline proteinuria group: pulse pressure, duration of hypertension, abnormal electrocardiogram result, non-high-density lipoprotein cholesterol level, serum urea nitrogen level, urine protein-creatinine ratio, urine sodium-potassium ratio, and annual income less than $15,000. Conclusion: Neither randomized class of antihypertensive therapy nor BP level had a significant effect on the occurrence of CV events, possibly because of limited power. However, this analysis identifies unique and potentially modifiable CV risk factors in this high-risk cohort.