Anemia is an independent risk factor for cardiovascular and renal events in hypertensive outpatients with well-controlled blood pressure: a subgroup analysis of the ATTEMPT-CVD randomized trial
Anemia is an independent risk factor for cardiovascular and renal events in hypertensive outpatients with well-controlled blood pressure: a subgroup analysis of the ATTEMPT-CVD randomized trial
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DOI：
10.1038/s41440-019-0210-1
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发表时间：
2019-06-01
影响因子：
5.4
通讯作者：
Matsui, Kunihiko
中科院分区：
文献类型：
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作者：
Kim-Mitsuyama, Shokei;Soejima, Hirofumi;Matsui, Kunihiko
为了研究贫血是否是高血压门诊患者心血管和肾脏事件的独立危险因素，我们基于基线血红蛋白对ATEATE-CVD研究进行了亚组分析。ATTENT-CVD研究是一项针对门诊高血压患者的多中心、前瞻性、随机研究，比较了3年来基于血管紧张素受体阻滞剂(ARB)的降压治疗和非ARB降压治疗的疗效。在本子分析中，ATTENT-CVD研究参与者(n=1213)根据他们的基线血红蛋白被分为贫血组和非贫血组。我们比较了贫血组和非贫血组的心血管和肾脏事件的发生率以及血压。我们还进行了多变量COX比例风险分析，以确定与心血管和肾脏事件独立相关的预后因素。在1213名参加心脑血管疾病试验的患者中，194名患者有贫血(主要是轻度贫血)，1019名患者没有。在3年的降压治疗中，贫血组和非贫血组的血压都得到了很好的控制。然而，贫血组心血管和肾脏事件的发生率显著高于非贫血组(HR=1.945：95%CI 1.208~3.130；P=0.0062)。即使在调整后，在血压控制良好的总体高血压患者中，贫血与心血管和肾脏事件独立相关(HR=1.816：95%CI 1.116-2.955；P=0.0163)。在血压得到很好控制的高血压门诊患者中，贫血，甚至轻度贫血，是心血管和肾脏事件的独立危险因素。因此，贫血可能是高血压门诊贫血患者心血管和肾脏疾病的新治疗靶点。
To investigate whether anemia is an independent risk factor for cardiovascular and renal events in hypertensive outpatients, we performed a subgroup analysis of the ATTEMPT-CVD study based on baseline hemoglobin. The ATTEMPT-CVD study was a multicenter, prospective, randomized study of hypertensive outpatients that compared the efficacy of angiotensin receptor blocker (ARB)-based antihypertensive treatment with non-ARB antihypertensive treatment over 3 years. In the present subanalysis, ATTEMPT-CVD study participants (n = 1213) were categorized into the anemic group and nonanemic group according to their baseline hemoglobin. We compared the anemic and nonanemic groups mainly in regard to the incidence of cardiovascular and renal events and blood pressure. We also performed a multivariable Cox proportional hazards analysis to determine the prognostic factors that were independently associated with cardiovascular and renal events. Of the 1213 patients enrolled in the ATTEMPT-CVD, 194 patients had anemia (mostly mild anemia) and 1019 patients did not. Blood pressure was well-controlled during the 3 years of antihypertensive therapy in both the anemic and nonanemic groups. However, the incidence of cardiovascular and renal events was significantly greater in the anemic group than in the nonanemic group (HR = 1.945: 95%CI 1.208-3.130; P = 0.0062). Even after adjustment, anemia was independently associated with cardiovascular and renal events (HR = 1.816: 95%CI 1.116-2.955; P = 0.0163) in overall hypertensive patients with well-controlled blood pressure. Anemia, even mild anemia, is an independent risk factor for cardiovascular and renal events in hypertensive outpatients whose blood pressure is well-controlled. Thus, anemia may be a novel therapeutic target for cardiovascular and renal diseases in hypertensive outpatients with anemia.