A Meta-Analysis on Prehypertension and Chronic Kidney Disease.
A Meta-Analysis on Prehypertension and Chronic Kidney Disease.
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高血压前期与慢性肾脏病的荟萃分析
DOI：
10.1371/journal.pone.0156575
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Chen L
中科院分区：
文献类型：
--
作者：
Li Y;Xia P;Xu L;Wang Y;Chen L
背景：最近的研究表明，高血压前期与终末期肾病风险增加有关。然而，关于高血压前期和慢性肾脏病（CKD）之间的关系，存在相互矛盾的证据。本荟萃分析旨在证明高血压前期与CKD发病率之间的相关性，并确定性别和种族差异的影响。方法检索MEDLINE、EMBASE、科克伦图书馆（从成立到2016年3月）和文献参考列表中关于血压和CKD的相关研究。血压（BP）测量值分为以下几类：最佳BP（小于120/80 mmHg）、高血压前期（120-139/80-89 mmHg）和高血压（超过140/90 mmHg）。CKD定义为估计肾小球滤过率（eGFR）<60 ml/min/1.73 m2或蛋白尿。两名研究者独立提取数据，并使用Newcastle-Ottawa量表（NOS）评估纳入本荟萃分析的研究质量。我们使用Stata/SE 12.0（StataCorp LP）进行荟萃分析。在异质性分析中使用随机效应模型。结果共检索到4,537篇潜在相关文献，根据预先确定的筛选标准，筛选出7个队列研究，包括261,264例受试者。五项研究在东亚的蒙古人中进行，另外两项研究在奥地利和伊朗的印欧人中进行。参与者的年龄从20岁到89岁不等，女性的比例从27.2%到63.8%不等。随访时间2 ~ 11年。与最佳血压值相比，高血压前期显示CKD的风险增加（合并RR = 1.28; 95%CI = 1.13-1.44; P = 0.000; I2 = 77.9%）。在性别分层分析中，我们在女性中发现了类似的趋势（汇总RR = 1.29; 95% CI = 1.01-1.63; P = 0.039; I2 = 76.1%），但在男性中没有发现。仅在来自东亚的蒙古人中观察到该效应（汇总RR = 1.37; 95% CI = 1.18-1.59; P = 0.000; I2 = 81.3%），而在印欧人中未观察到该效应。结论高血压前期是CKD的潜在病因之一。性别和种族差异在这种联系中表现出来。
Background Recent studies have demonstrated that there is an association between prehypertension and an increased risk of end-stage renal disease. However, there is conflicting evidence regarding the relationship between prehypertension and chronic kidney disease (CKD). This meta-analysis aimed to demonstrate the association between prehypertension and the incidence of CKD and identify the impacts of gender and ethnic differences. Methods MEDLINE, EMBASE, Cochrane Library (from inception through March 2016) and article reference lists were searched for relevant studies regarding blood pressure and CKD. Blood pressure (BP) measurements were classified as follows: optimal BP (less than 120/80 mmHg), prehypertension (120-139/80-89 mmHg) and hypertension (over 140/90 mmHg). CKD was defined by estimated glomerular filtration rate (eGFR)<60 ml/min/1.73 m2 or proteinuria. Two investigators independently extracted the data and assessed the quality of studies enrolled in this meta-analysis using the Newcastle-Ottawa Scale (NOS). We performed the meta-analysis using Stata/SE 12.0 (StataCorp LP). The random-effect models were used in the heterogeneous analyses. Results After retrieving data from 4,537 potentially relevant articles, we identified 7 cohort studies including 261,264 subjects, according to the predefined selection criteria. Five studies were conducted in Mongolians from East Asia, and the other two studies were performed in Indo-Europeans from Austria and Iran. The participants ranged in age from 20 to 89 years, and the proportion of females ranged from 27.2% to 63.8%. The follow-up period ranged from 2 to 11 years. Compared with the optimal BP values, prehypertension showed an increased risk of CKD (pooled RR = 1.28; 95% CI = 1.13–1.44; P = 0.000; I2 = 77.9%). In the sex-stratified analysis, we found a similar trend in women (pooled RR = 1.29; 95% CI = 1.01–1.63; P = 0.039; I2 = 76.1%) but not in men. This effect was observed only in Mongolians from East Asia (pooled RR = 1.37; 95% CI = 1.18–1.59; P = 0.000; I2 = 81.3%) and not in Indo-Europeans. Conclusions Prehypertension is considered a potential cause of CKD. Gender and ethnic differences are exhibited in this association.