Prevalence and Prognostic Role of Resistant Hypertension in Chronic Kidney Disease Patients
Prevalence and Prognostic Role of Resistant Hypertension in Chronic Kidney Disease Patients
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DOI：
10.1016/j.jacc.2012.12.061
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发表时间：
2013-06-18
影响因子：
24
通讯作者：
Minutolo, Roberto
中科院分区：
文献类型：
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作者：
De Nicola, Luca;Gabbai, Francis B.;Minutolo, Roberto
目的本研究旨在评估慢性肾脏疾病（CKD）中真正抵抗性高血压（RH）的患病率和预后（即通过动态血压[ABP]监测证实）。背景：在CKD中，未控制的高血压是一个主要的危险因素，但没有研究适当地调查RH的作用。方法对436例接受肾内科护理的高血压慢性肾病患者进行前瞻性研究。将24小时ABP与RH诊断相结合分为四组（尽管坚持使用>= 3种含利尿剂的全剂量降压药或>= 4种降压药，但办公室血压>= 130/80 mm Hg）和对照组（ABP = 125/75 mm Hg伴RH）。生存分析的终点是肾脏（终末期肾脏疾病或死亡）和心血管事件（致命和非致命心血管事件）。结果年龄65 +/- 14岁，男性占58%，糖尿病占36%，心血管疾病占30%，中位蛋白尿0.24（四分位数范围0.09 ~ 0.83）g/d，肾小球滤过率43 +/- 20 ml/min/1.73 m(2)，血压146 +/- 19/82 +/- 12 mm Hg， 24小时ABP 129 +/- 17/72 +/- 10 mm Hg，真正耐药患者占22.9%，假性耐药患者占7.1%，而持续高血压患者占42.9%，对照组占27.1%。在57个月的随访中，发生了109例心血管事件和165例肾脏事件。与对照组相比，假耐药组心血管风险（危险比[95%置信区间]）为1.24(0.55 ~ 2.78)，持续高血压组为1.11(0.67 ~ 1.84)，真耐药组为1.98（1.14 ~ 3.43）。肾脏事件的相应危险度分别为1.18（0.45 - 3.13）、2.14（1.35 - 3.40）和2.66（1.62 - 4.37）。在CKD中，假性耐药与心肾风险增加无关，持续高血压仅预测肾脏预后。真正的耐药性是普遍存在的，并确定了具有最高心血管风险的患者。(C) 2013年由美国心脏病学会基金会发布
Objectives This study sought to evaluate in chronic kidney disease (CKD) prevalence and prognosis of true resistant hypertension (RH) (i.e., confirmed by ambulatory blood pressure [ABP] monitoring).Background In CKD, uncontrolled hypertension is a major risk factor, but no study has properly investigated the role of RH.Methods We prospectively studied 436 hypertensive CKD patients under nephrology care. Four groups were constituted by combining 24-h ABP with diagnosis of RH (office blood pressure >= 130/80 mm Hg, despite adherence to >= 3 full-dose antihypertensive drugs including a diuretic agent or >= 4 drugs): control (ABP = 125/75 mm Hg with RH). Endpoints of survival analysis were renal (end-stage renal disease or death) and cardiovascular events (fatal and nonfatal cardiovascular event).Results Age was 65 +/- 14 years, men 58%, diabetes 36%, cardiovascular disease 30%, median proteinuria 0.24 (interquartile range 0.09 to 0.83) g/day, estimated glomerular filtration rate 43 +/- 20 ml/min/1.73 m(2), office blood pressure 146 +/- 19/82 +/- 12 mm Hg, and 24-h ABP 129 +/- 17/72 +/- 10 mm Hg. True resistant patients were 22.9%, and pseudoresistant patients were 7.1%, whereas patients with sustained hypertension were 42.9%, and control subjects were 27.1%. Over 57 months of follow-up, 109 cardiovascular events and 165 renal events occurred. Cardiovascular risk (hazard ratio [95% confidence interval]) was 1.24 (0.55 to 2.78) in pseudoresistance, 1.11 (0.67 to 1.84) in sustained hypertension, and 1.98 (1.14 to 3.43) in true resistance, compared with control subjects. Corresponding hazards for renal events were 1.18 (0.45 to 3.13), 2.14 (1.35 to 3.40), and 2.66 (1.62 to 4.37).Conclusions In CKD, pseudoresistance is not associated with an increased cardio-renal risk, and sustained hypertension predicts only renal outcome. True resistance is prevalent and identifies patients carrying the highest cardiovascular risk. (C) 2013 by the American College of Cardiology Foundation