Association of visit-to-visit variability in blood pressure and first stroke risk in hypertensive patients with chronic kidney disease
Association of visit-to-visit variability in blood pressure and first stroke risk in hypertensive patients with chronic kidney disease
复制标题
高血压合并慢性肾病患者血压每次访视变异性与首次卒中风险的关系
DOI：
10.1097/hjh.0000000000002306
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发表时间：
2020-04-01
影响因子：
4.9
通讯作者：
Qin, Xianhui
中科院分区：
文献类型：
--
作者：
Li, Youbao;Zhou, Huamin;Qin, Xianhui
目的：关于血压（BP）访视间变异性（VVV）与高血压伴慢性肾脏病（CKD）患者卒中风险之间相关性的数据有限。我们的目的是评估血压VVV与卒中风险的关系，并检查轻中度CKD高血压患者中任何可能的效应调节剂。方法：这是对中国脑卒中一级预防试验的事后分析。共纳入3091例基线时估计肾小球滤过率为30-60 ml/min/1.73 m2和/或蛋白尿、未发生卒中且从随机化至12个月访视至少有两次访视的血压测量值的患者。BP的主要VVV以SD表示。主要结局为首次卒中。结果：中位后续治疗持续时间为3.7年。在多变量校正后，包括基线SBP和第一个12个月随访期间的平均SBP，SD SBP与随后的首次卒中风险呈显著正相关（每SD增量;比值比，1.41; 95%置信区间：1.17-1.69）和首次缺血性卒中（比值比，1.55; 95%置信区间：1.26-1.90）。不同亚组的结果一致，包括年龄、性别、基线SBP、治疗依从性和平均SBP、前12个月随访期间钙通道阻滞剂的伴随使用。SBP的变异系数和DBP的SD或变异系数也有类似的趋势。然而，血压变异性与首次出血性卒中之间无显著相关性。总结：在轻中度慢性肾病的高血压成人患者中，访视间血压变异性与随后首次卒中的风险显著相关。
Objective: Data on the association between visit-to-visit variability (VVV) in blood pressure (BP) and the risk of stroke among hypertensive patients with chronic kidney disease (CKD) is limited. We aimed to evaluate the relation of VVV in BP with the risk of stroke, and examine any possible effect modifiers in hypertensive patients with mild-to-moderate CKD. Methods: This is a post-hoc analysis of the China Stroke Primary Prevention Trial. A total of 3091 patients with estimated glomerular filtration rate 30-60 ml/min per 1.73 m(2) and/or proteinuria at baseline, without occurring stroke and with BP measurements of at least two visits from randomization to the 12-month visit were included. The main VVV in BP was expressed as SD. The primary outcome was first stroke. Results: The median subsequent treatment duration was 3.7 years. After multivariable adjustment, including baseline SBP and mean SBP during the first 12-month follow-up, there was a significantly positive relationship of SD SBP with the risk of subsequent first stroke (per SD increment; odds ratio, 1.41; 95% confidence interval: 1.17-1.69) and first ischemic stroke (odds ratio, 1.55; 95% confidence interval: 1.26-1.90). Results were consistent across various subgroups, including age, sex, baseline SBP, treatment compliance, and mean SBP, concomitant usage of calcium channel blocker during the first 12-month follow-up period. Similar trends were also found for coefficient of variation SBP, and SD or coefficient of variation DBP. However, there was no significant association between BP variability and first hemorrhagic stroke. Conclusion: In hypertensive adults with mild-to-moderate CKD, visit-to-visit variability in BP was significantly associated with the risk of subsequent first stroke.