Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study
Association Between Hypertension and Kidney Function Decline: The Atherosclerosis Risk in Communities (ARIC) Study
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DOI：
10.1053/j.ajkd.2019.02.015
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发表时间：
2019-09-01
影响因子：
13.2
通讯作者：
Grams, Morgan E.
中科院分区：
文献类型：
--
作者：
Yu, Zhi;Rebholz, Casey M.;Grams, Morgan E.
理论与目的：高血压、抗高血压药物的使用和肾小球滤过率(GFR)随时间的变化之间的关系需要调查。研究设计：观察性研究。背景和参与者：来自社区动脉粥样硬化风险(ARIC)研究的14,854名参与者。预测因素：基线高血压状态(1987-1989)根据2017年美国心脏病学会/美国心脏协会临床实践指南分类为正常血压、高血压、1期高血压、2期高血压。分析方法：随机截距和随机斜率的混合模型适合于评估基线高血压状态与eGFR斜率之间的关系。结果：在基线水平，白人和非裔美国人分别有13.2%、7.3%和19.4%的白人和15.8%、14.9%和39.9%的非裔美国人患有第1期高血压、第2期高血压和第2期高血压。与血压正常者相比，高血压患者的EGFR年降幅更大(白人：血压升高，-0.11毫升/分/1.73米(2)；高血压1期，-0.15毫升/分/1.73米(2)；高血压2期，未用药，-0.36毫升/分/1.73米(2)；高血压2期，-0.17毫升/分/1.73米(2)；非裔美国人：高血压，-0.21毫升/分钟/1.73米(2)；第一阶段高血压，-0.16毫升/分钟/1.73米(2)；第二阶段高血压，未用药，-0.50毫升/分钟/1.73米(2)；第二阶段高血压，-0.16毫升/分钟/1.73米(2))。在白人中，血压正常、血压升高、1期高血压、2期高血压、2期高血压和2期高血压伴药物治疗的30年预测G3a+期慢性肾脏病的概率分别为54.4%、61.6%、64.7%、78.1%和70.9%，在非裔美国人中分别为55.4%、62.8%、60.9%、76.1%和66.6%。结论：在一般人群队列中，与正常血压相比，基线高血压状态与30年随访中肾功能下降更快相关。在使用降压药的人中，这种差异被减弱。
Rationale & Objective: The relationship between hypertension, antihypertension medication use, and change in glomerular filtration rate (GFR) over time among individuals with preserved GFR requires investigation.Study Design: Observational study.Setting & Participants: 14,854 participants from the Atherosclerosis Risk in Communities (ARIC) Study.Predictors: Baseline hypertension status (1987-1989) was categorized according to the 2017 American College of Cardiology/American Heart Association Clinical Practice Guideline as normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication.Outcomes: Slope of estimated GFR (eGFR) at 5 study visits over 30 years.Analytical Approach: Mixed models with random intercepts and random slopes were fit to evaluate the association between baseline hypertension status and slope of eGFR.Results: At baseline, 13.2%, 7.3%, and 19.4% of whites and 15.8%, 14.9%, and 39.9% of African Americans had stage 1 hypertension, stage 2 hypertension without medication, and stage 2 hypertension with medication. Compared with those with normal blood pressure, the annual eGFR decline was greater in people with higher blood pressure (whites: elevated blood pressure, -0.11 mL/min/1.73 m(2); stage 1 hypertension, -0.15 mL/min/1.73 m(2); stage 2 hypertension without medication, -0.36 mL/min/1.73 m(2) ; stage 2 hypertension with medication, -0.17 mL/min/1.73 m(2) ; African Americans: elevated blood pressure, -0.21 mL/min/1.73 m(2) ; stage 1 hypertension, -0.16 mL/min/1.73 m(2) ; stage 2 hypertension without medication, -0.50 mL/min/1.73 m(2) ; stage 2 hypertension with medication, -0.16 mL/min/1.73 m(2)). The 30-year predicted probabilities of developing chronic kidney disease stage G3a+ with normal blood pressure, elevated blood pressure, stage 1 hypertension, stage 2 hypertension without medication, or stage 2 hypertension with medication among whites were 54.4%, 61.6%, 64.7% 78.1%, and 70.9%, respectively, and 55.4%, 62.8%, 60.9%, 76.1%, and 66.6% among African Americans.Limitations: Slope estimated using a maximum of 5 eGFR assessments; differential loss to follow-up.Conclusions: Compared to normotension, baseline hypertension status was associated with faster kidney function decline over 30-year follow-up in a general population cohort. This difference was attenuated among people using antihypertensive medications.