Prognostic significance of renal function in elderly patients with isolated Systolic hypertension:: Results from the Syst-eur trial
Prognostic significance of renal function in elderly patients with isolated Systolic hypertension:: Results from the Syst-eur trial
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DOI：
10.1097/01.asn.0000027871.86296.92
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发表时间：
2002-09-01
影响因子：
13.6
通讯作者：
Staessen, JA
中科院分区：
文献类型：
--
作者：
De Leeuw, PW;Thijs, L;Staessen, JA
一些报告表明，肾功能的标志物，如血清肌酐，血清尿酸和尿蛋白排泄可能与心血管并发症和死亡率有关。本研究分析了来自Syst-Eur试验的数据，该试验是一项在老年单纯收缩期高血压患者中进行的随机、安慰剂对照、双盲干预试验。目的是评估入组时血清肌酐、尿酸水平和尿蛋白排泄是否与随后的发病率和死亡率相关。根据血清肌酐或血清尿酸的每五分位数或每种蛋白排泄（无、微量和明显），计算总死亡率、心血管死亡率、卒中（致死性和非致死性）、冠状动脉事件和所有心血管终点的发生率。对于血清肌酐每增加20 μ M，血清尿酸每增加50 μ M，以及每种蛋白质排泄类别，也确定了粗的和调整的相对危险率。即使调整了年龄、性别和其他各种协变量，血清肌酐也与预后不良显著相关。血尿酸水平与总死亡率呈U型关系，但对混杂变量进行适当调整后，血尿酸水平与并发症无明显相关性。入组时的蛋白尿是总死亡率和所有心血管终点的重要预测因子。它的结论是，较高水平的血清肌酐和微量或烤箱蛋白尿与心血管事件的数量增加，并与孤立性收缩期高血压患者的死亡率较高。
Several reports suggest that markers of renal function such as serum creatinine, serum uric acid, and urinary excretion of protein may be related to cardiovascular complications and mortality. This study analyzed the data from the Syst-Eur trial, which was a randomized, placebo-controlled, double-blind intervention trial in elderly patients with isolated systolic hypertension. The purpose was to evaluate whether serum levels of creatinine and uric acid and urinary protein excretion at entry are related to subsequent morbidity and mortality. Incidence rates of total mortality, cardiovascular mortality, stroke (fatal as well as nonfatal), coronary events, and all cardiovascular endpoints were calculated for each quintile of serum creatinine or serum uric acid or for each category of protein excretion (none, trace, and overt). Crude and adjusted relative hazard rates were also determined for each 20 muM increase in serum creatinine, each 50 muM increase in serum uric acid, and for each protein excretion category. Even when adjusted for age, gender, and various other covariates, serum creatinine was significantly associated with a worse prognosis. There was an U-shaped relationship between serum uric acid and total mortality, but otherwise no obvious relationships were detected between serum uric acid levels and complications when appropriate adjustments were made for confounding variables. Proteinuria at entry was a significant predictor of total mortality and all cardiovascular endpoints. It is concluded that higher levels of serum creatinine and trace or oven proteinuria are associated with an increased number of cardiovascular events and with a higher mortality in patients with isolated systolic hypertension.