Association of Blood Pressure Variability and Diuretics With Cardiovascular Events in Patients With Chronic Kidney Disease Stages 1-5.
Association of Blood Pressure Variability and Diuretics With Cardiovascular Events in Patients With Chronic Kidney Disease Stages 1-5.
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DOI：
10.1161/hypertensionaha.120.16117
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发表时间：
2021-03-03
期刊：
影响因子：
--
通讯作者：
Alvarez CA
中科院分区：
文献类型：
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作者：
Gregg LP;Hedayati SS;Yang H;Van Buren PN;Banerjee S;Navaneethan SD;Virani SS;Winkelmayer WC;Alvarez CA
在一般人群中，访视间血压变异性（BPV）与心血管事件相关。慢性肾脏病（CKD）的数据很少。我们假设BPV与心血管结局、死亡和终末期肾病（ESKD）相关，利尿剂可改变CKD患者的这些相关性。我们研究了接受非利尿抗高血压单药治疗的非透析CKD 1-5期和高血压的美国退伍军人。在第二次使用抗高血压药物处方时，我们对袢或噻嗪类利尿剂与任何其他抗高血压药物的暴露进行了倾向性匹配。BPV定义为第二次药物处方后6个月内收缩压的变异系数。考克斯比例风险回归测量了BPV与主要心血管事件复合终点（致死性或非致死性心肌梗死或缺血性卒中;心力衰竭住院）的相关性。次要结局包括全因死亡、每个主要结局组分、ESKD和心血管死亡。每组有31，394名参与者。BPV与复合心血管事件相关，第二、第三、第四和第五个五分位数与第一个五分位数的风险比（95%置信区间）：1.79（1.53-2.11）、2.32（1.99-2.71）、2.60（2.24-3.02）和3.12（2.68-3.62）。利尿剂减弱了第四和第五BPV五分位数与复合事件之间的相关性（P相互作用分别=0.03和0.04）。BPV与除ESKD外的所有次要结局相关，无利尿剂相互作用。BPV与CKD患者的心血管事件和死亡相关，但与ESKD无关，在高BPV五分位数的利尿剂治疗组中，与CV事件的相关性减弱。未来的研究应调查是否其他抗高血压类修改这些风险。
Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular events in the general population. Data are scarce in chronic kidney disease (CKD). We hypothesized that BPV would be associated with cardiovascular outcomes, death, and end-stage kidney disease (ESKD) and that diuretics would modify these associations in patients with CKD. We studied U.S. Veterans with non-dialysis CKD stages 1-5 and hypertension on non-diuretic antihypertensive monotherapy. At the time of second antihypertensive agent prescription, we propensity-matched for exposure to a loop or thiazide diuretic vs. any other antihypertensive. BPV was defined as the coefficient of variation of systolic blood pressure over 6 months after second agent prescription. Cox proportional hazards regression measured associations of BPV with a primary cardiovascular event composite (fatal or non-fatal myocardial infarction or ischemic stroke; heart failure hospitalization). Secondary outcomes included all-cause death, each primary outcome component, ESKD, and cardiovascular death. There were 31,394 participants in each group. BPV was associated with composite cardiovascular events, hazard ratio (95% confidence interval) at second, third, fourth, and fifth vs. first quintile: 1.79 (1.53-2.11), 2.32 (1.99-2.71), 2.60 (2.24-3.02), and 3.12 (2.68-3.62). Diuretics attenuated associations between the fourth and fifth BPV quintiles with composite events (Pinteraction=0.03 and 0.04, respectively). BPV was associated with all secondary outcomes except ESKD, with no diuretic interactions. BPV was associated with cardiovascular events and death but not ESKD in patients with CKD, with attenuated associations with CV events in the diuretic-treated group at high BPV quintiles. Future studies should investigate whether other antihypertensive classes modify these risks.