Isolated Diastolic Hypertension and Kidney and Cardiovascular Outcomes in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study.
Isolated Diastolic Hypertension and Kidney and Cardiovascular Outcomes in CKD: The Chronic Renal Insufficiency Cohort (CRIC) Study.
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DOI：
10.1016/j.xkme.2023.100728
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发表时间：
2023-12
期刊：
影响因子：
3.9
通讯作者：
Pradhan, Nishigandha
中科院分区：
文献类型：
--
作者：
Al Saleh, Saud;Dobre, Mirela;DeLozier, Sarah;Perez, Jaime;Patil, Nirav;Rahman, Mahboob;Pradhan, Nishigandha
单纯舒张期高血压在慢性肾脏病（CKD）患者中的临床意义尚不清楚。我们评估了慢性肾功能不全队列（CRIC）研究参与者中单纯舒张期高血压的患病率及其与不良肾脏和心血管结局的相关性。前瞻性队列研究。具有完整的收缩压（SBP）和舒张压（DBP）基线数据的CRIC研究参与者（N= 5，621）。单纯舒张期高血压定义为SBP ≤ 130 mm Hg且DBP >80 mm Hg。血压正常，定义为SBP ≤ 130 mm Hg和DBP ≤ 80 mm Hg。复合肾脏事件（估计肾小球滤过率下降50%或发生肾衰竭）、复合心血管事件（心肌梗死、心力衰竭、卒中或外周动脉疾病）和全因死亡率。根据人口统计学、健康行为和临床协变量调整的考克斯比例风险模型。在5，621名参与者中，347名（6.2%）患有单纯舒张期高血压。在347例单纯舒张期高血压患者中，单纯舒张期高血压与复合肾脏结局之间无相关性（HR，1.17; 95% CI，0.93-1.47; P = 0.18），复合心血管事件（HR，0.91; 95% CI，0.65-1.27; P = 0.58）或全因死亡率（HR，0.82; 95% CI，0.57-1.19; P = 0.30）。队列年龄较大和亚裔受试者数量较少限制了研究结果的普遍性。相对较小的样本量不足以检测与结果的适度关联。单纯舒张期高血压与CKD受试者的不良肾脏和心血管事件风险无关。临床医生经常遇到患有肾脏疾病的患者，他们控制了收缩压（BP），但舒张压高，不知道他们是否应该加强BP治疗以控制舒张压。我们研究了收缩压得到控制但舒张压不受控制是否会导致慢性肾脏疾病患者的心脏和肾脏结局恶化。我们没有发现任何这样的关联。然而，我们的研究规模相对较小，并且存在一些局限性。在更大规模的研究证实或反驳这一发现之前，如果慢性肾脏疾病患者的收缩压已经得到良好控制，我们建议不要增加血压药物来改善舒张压控制。
The clinical significance of isolated diastolic hypertension in patients with chronic kidney disease (CKD) is unclear. We assessed the prevalence of isolated diastolic hypertension and its association with adverse kidney and cardiovascular outcomes in participants in the Chronic Renal Insufficiency Cohort (CRIC) study. Prospective cohort study. CRIC study participants with complete baseline data on systolic blood pressure (SBP) and diastolic BP (DBP) (N=5,621). Isolated diastolic hypertension defined as SBP ≤ 130 mm Hg and DBP >80 mm Hg. Normotension, defined as SBP ≤ 130 mm Hg and DBP ≤ 80 mm Hg. Composite kidney events (50% decline in estimated glomerular filtration rate or onset of kidney failure), composite cardiovascular events (myocardial infarction, heart failure, stroke, or peripheral arterial disease), and all-cause mortality. Cox proportional hazards models adjusted for demographic, health behavior, and clinical covariates. Of the 5,621 participants, 347 (6.2%) had isolated diastolic hypertension. Among the 347 participants with isolated diastolic hypertension, there was no association between isolated diastolic hypertension and the composite kidney outcome (HR, 1.17; 95% CI, 0.93-1.47; P = 0.18), composite cardiovascular events (HR, 0.91; 95% CI, 0.65-1.27; P = 0.58), or all-cause mortality (HR, 0.82; 95% CI, 0.57-1.19; P = 0.30). Older age of cohort and low number of participants of Asian ethnicity limit generalizability of findings. A relatively small sample size is inadequate to detect modest associations with outcomes. Isolated diastolic hypertension was not associated with the risk of adverse kidney and cardiovascular events in participants with CKD. Clinicians frequently encounter patients with kidney disease who have controlled systolic blood pressure (BP) but high diastolic BP and do not know whether they should intensify BP treatment in an attempt to control the diastolic BP. We examined whether having controlled systolic BP but uncontrolled diastolic BP leads to worse heart and kidney outcomes in patients with chronic kidney disease. We did not find any such association. However, our study was relatively small and had a number of limitations. Till larger studies confirm or refute this finding, we recommend not increasing blood pressure medications to improve the diastolic BP control if the systolic BP is already well controlled in patients with chronic kidney disease.
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影响因子：
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作者：
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作者：
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DOI：
10.18632/aging.202609
发表时间：
2021-02-22
期刊：
Aging
影响因子：
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作者：
Hao Y;Li X;Zhu Y;Ke J;Lou T;Li M;Wang C
通讯作者：
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