Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension.
Comparative risk of renal, cardiovascular, and mortality outcomes in controlled, uncontrolled resistant, and nonresistant hypertension.
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DOI：
10.1038/ki.2015.142
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发表时间：
2015-09
影响因子：
19.6
通讯作者：
Jacobsen SJ
中科院分区：
文献类型：
--
作者：
Sim JJ;Bhandari SK;Shi J;Reynolds K;Calhoun DA;Kalantar-Zadeh K;Jacobsen SJ
我们试图比较470386例顽固性和非顽固性高血压（non-RH）患者的终末期肾病（ESRD）、缺血性心脏事件（IHE）、充血性心力衰竭（CHF）、脑血管意外（CVA）和全因死亡率的风险。顽固性高血压（60327例）分为两组；在一项为期5年的回顾性队列研究中，23104例cRH患者（接受4种或更多药物控制）和37223例uRH患者（接受3种或更多药物控制）。Cox比例风险模型用于估计校正年龄、性别、种族、体重指数、慢性肾脏疾病（CKD）和合并症的风险比。顽固性高血压（cRH和uRH）与非rh相比，ESRD、IHE、CHF、CVA和死亡率的多变量校正风险比（95%置信区间）分别为1.32（1.27-1.37）、1.24（1.20-1.28）、1.46（1.40-1.52）、1.14（1.10-1.19）和1.06（1.03-1.08）。uRH与cRH比较，ESRD、IHE、CHF、CVA和死亡率的风险比分别为1.25（1.18-1.33）、1.04（0.99-1.10）、0.94（0.89-1.01）、1.23（1.14-1.31）和1.01（0.97-1.05）。在所有三个队列中，男性和西班牙裔患者发生ESRD的风险更高。顽固性高血压发生ESRD、IHE、CHF、CVA和死亡率的风险更高。与cRH相比，uRH组ESRD和CVA的风险分别高出25%和23%，支持血压与两种结果之间的联系。
We sought to compare the risk of end stage renal disease (ESRD), ischemic heart event (IHE), congestive heart failure (CHF), cerebrovascular accident (CVA), and all-cause mortality among 470,386 individuals with resistant and nonresistant hypertension (non-RH). Resistant hypertension (60,327 individuals) was sub-categorized into 2 groups; 23,104 patients with cRH (controlled on 4 or more medicines) and 37,223 patients with uRH (uncontrolled on 3 or more medicines) in a 5 year retrospective cohort study. Cox proportional hazard modeling was used to estimate hazard ratios adjusting for age, gender, race, body mass index, chronic kidney disease (CKD), and co-morbidities. Resistant hypertension (cRH and uRH) compared to non-RH, had multivariable adjusted hazard ratios (95% confidence intervals) of 1.32 (1.27–1.37), 1.24 (1.20–1.28), 1.46 (1.40–1.52), 1.14 (1.10–1.19), and 1.06 (1.03–1.08) for ESRD, IHE, CHF, CVA, and mortality, respectively. Comparison of uRH to cRH had hazard ratios of 1.25 (1.18–1.33), 1.04 (0.99–1.10), 0.94 (0.89–1.01), 1.23 (1.14–1.31), and 1.01 (0.97–1.05) for ESRD, IHE, CHF, CVA, and mortality, respectively. Males and Hispanics had greater risk for ESRD within all 3 cohorts. Resistant hypertension had greater risk for ESRD, IHE, CHF, CVA, and mortality. The risk of ESRD and CVA and were 25% and 23% greater, respectively, in uRH compared to cRH supporting the linkage between blood pressure and both outcomes.