ASSOCIATION OF THE RENIN SODIUM PROFILE WITH THE RISK OF MYOCARDIAL-INFARCTION IN PATIENTS WITH HYPERTENSION
ASSOCIATION OF THE RENIN SODIUM PROFILE WITH THE RISK OF MYOCARDIAL-INFARCTION IN PATIENTS WITH HYPERTENSION
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DOI：
10.1056/nejm199104183241605
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发表时间：
1991-04-18
影响因子：
158.5
通讯作者：
LARAGH, JH
中科院分区：
文献类型：
--
作者：
ALDERMAN, MH;MADHAVAN, S;LARAGH, JH
背景。 为了前瞻性地测试血浆肾素活性的预后价值，我们在系统的工作现场治疗计划中确定了 1717 名轻度至中度高血压受试者（平均年龄 53 岁；36% 白人；67% 男性）的治疗前肾素钠谱。方法。 肾素谱是通过绘制血浆肾素活性与尿钠排泄量的关系图获得的，分为高（12％的受试者）、正常（56％）和低（32％），并且根据年龄、性别和种族存在预期的变化。 改良的高血压分级护理治疗（不参考肾素谱）在三个肾素组中的情况相似。结果。 肾素水平较高的受试者的入组时平均血压（+/- SD）为 151 +/- 19/100 +/- 10 mm Hg，肾素水平正常的受试者为 151 +/- 19/97 +/- 10 mm Hg，肾素水平较低的受试者为 151 +/- 20/96 +/- 11 mm Hg。 在8.3年的随访期间，出现27例心肌梗塞。 根据年龄、性别和种族进行调整后，肾素水平高的受试者每 1000 人年的心肌梗死发病率为 14.7，肾素水平正常的受试者为 5.6，肾素水平低的受试者为 2.8（高与低的比率为 5.3；95% 置信区间为 3.4 至 8.3）。 高轮廓组的全因死亡率为 9.3，正常轮廓组为 5.3，低轮廓组为 3.9。 在调整种族、性别、入组年龄、血清胆固醇水平、吸烟状况、左心室肥大的心电图证据、血糖水平、体重指数、心血管疾病或治疗史、血压、和β-受体阻滞剂的使用。结论。 在研究人群中，治疗前和治疗期间的血压范围很窄，并且考虑了其他心血管危险因素后，治疗前的肾素谱仍然与随后的心肌梗死风险独立相关。
Background. To test the prognostic value of plasma renin activity prospectively, we determined the pretreatment renin-sodium profile of 1717 subjects with mild-to-moderate hypertension (mean age, 53 years; 36 percent white; 67 percent men) in a systematic work-site treatment program.Methods. Renin profiles, obtained by plotting plasma renin activity against the urinary excretion of sodium, were classified as high (12 percent of the subjects), normal (56 percent), and low (32 percent), and there were expected variations according to age, sex, and race. Modified stepped-care treatment for hypertension, prescribed without reference to the renin profile, was similar in the three renin groups.Results. Mean (+/- SD) blood pressure at entry was 151 +/- 19/100 +/- 10 mm Hg in the subjects with a high renin profile, 151 +/- 19/97 +/- 10 mm Hg in those with a normal profile, and 151 +/- 20/96 +/- 11 mm Hg in those with a low profile. During 8.3 years of follow-up, there were 27 myocardial infarctions. As adjusted for age, sex, and race, the incidence of myocardial infarction per 1000 person-years was 14.7 among the subjects with a high renin profile, 5.6 among those with a normal profile, and 2.8 among those with a low profile (rate ratio for high vs. low, 5.3; 95 percent confidence interval, 3.4 to 8.3). The rate of mortality from all causes was 9.3 in the high-profile group, 5.3 in the normal-profile group, and 3.9 in the low-profile group. The independent association of a high renin profile with myocardial infarction (but not with stroke or noncardiovascular events) was affirmed by Cox analyses (rate ratio for high vs. normal plus low, 3.2; 95 percent confidence interval, 1.2 to 8.4) after adjustment for race, sex, age at entry, serum cholesterol level, smoking status, electrocardiographic evidence of left ventricular hypertrophy, blood glucose level, body-mass index, history of cardiovascular disease or treatment, blood pressure, and use of beta-blockers.Conclusions. In the study population, whose blood pressure before and during treatment was in a narrow range, and after other cardiovascular risk factors had been considered, the renin profile before treatment remained independently associated with the subsequent risk of myocardial infarction.