Intensive blood-pressure control in hypertensive chronic kidney disease.
Intensive blood-pressure control in hypertensive chronic kidney disease.
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DOI：
10.1056/nejmoa0910975
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发表时间：
2010-09-02
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影响因子：
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通讯作者：
AASK Collaborative Research Group
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作者：
Appel LJ;Wright JT Jr;Greene T;Agodoa LY;Astor BC;Bakris GL;Cleveland WH;Charleston J;Contreras G;Faulkner ML;Gabbai FB;Gassman JJ;Hebert LA;Jamerson KA;Kopple JD;Kusek JW;Lash JP;Lea JP;Lewis JB;Lipkowitz MS;Massry SG;Miller ER;Norris K;Phillips RA;Pogue VA;Randall OS;Rostand SG;Smogorzewski MJ;Toto RD;Wang X;AASK Collaborative Research Group
在观察性研究中，血压和终末期肾病（ESRD）之间的关系是直接和进行性的。高血压相关慢性肾脏疾病和终末期肾病的负担在黑人患者中尤其高。然而，很少有试验测试是否强化血压控制延缓黑人患者慢性肾脏疾病的进展。我们将1094名患有高血压慢性肾病的黑人患者随机分为两组，一组接受强化血压控制，另一组接受标准血压控制。完成试验阶段后，患者被邀请入组血压目标低于130/80 mm Hg的队列阶段。队列阶段的主要临床结局是慢性肾病的进展，其定义为血清肌酸酐水平加倍、诊断为ESRD或死亡。随访时间为8.8 ~ 12.2年。在试验阶段，强化对照组的平均血压为130/78 mm Hg，标准对照组为141/86 mm Hg。在队列阶段，相应的平均血压为131/78 mm Hg和134/78 mm Hg。在两个阶段中，主要结局的风险没有显著的组间差异（强化对照组的风险比为0.91; P = 0.27）。然而，根据蛋白尿的基线水平，效果不同（相互作用P = 0.02），在蛋白质与肌酐比值大于0.22的患者中可能获益（风险比，0.73; P = 0.01）。在总体分析中，强化血压控制对肾脏疾病进展没有影响。然而，强化血压控制对有和无基线蛋白尿的患者可能有不同的影响。（由国家糖尿病、消化和肾脏疾病研究所、国家少数民族健康和健康差异中心等资助。
In observational studies, the relationship between blood pressure and end-stage renal disease (ESRD) is direct and progressive. The burden of hypertension-related chronic kidney disease and ESRD is especially high among black patients. Yet few trials have tested whether intensive blood-pressure control retards the progression of chronic kidney disease among black patients. We randomly assigned 1094 black patients with hypertensive chronic kidney disease to receive either intensive or standard blood-pressure control. After completing the trial phase, patients were invited to enroll in a cohort phase in which the blood-pressure target was less than 130/80 mm Hg. The primary clinical outcome in the cohort phase was the progression of chronic kidney disease, which was defined as a doubling of the serum creatinine level, a diagnosis of ESRD, or death. Follow-up ranged from 8.8 to 12.2 years. During the trial phase, the mean blood pressure was 130/78 mm Hg in the intensive-control group and 141/86 mm Hg in the standard-control group. During the cohort phase, corresponding mean blood pressures were 131/78 mm Hg and 134/78 mm Hg. In both phases, there was no significant between-group difference in the risk of the primary outcome (hazard ratio in the intensive-control group, 0.91; P = 0.27). However, the effects differed according to the baseline level of proteinuria (P = 0.02 for interaction), with a potential benefit in patients with a protein-to-creatinine ratio of more than 0.22 (hazard ratio, 0.73; P = 0.01). In overall analyses, intensive blood-pressure control had no effect on kidney disease progression. However, there may be differential effects of intensive blood-pressure control in patients with and those without baseline proteinuria. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases, the National Center on Minority Health and Health Disparities, and others.)