ETHNICITY AND RENAL-DISEASE - LESSONS FROM THE MULTIPLE RISK FACTOR INTERVENTION TRIAL AND THE TREATMENT OF MILD HYPERTENSION STUDY
ETHNICITY AND RENAL-DISEASE - LESSONS FROM THE MULTIPLE RISK FACTOR INTERVENTION TRIAL AND THE TREATMENT OF MILD HYPERTENSION STUDY
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DOI：
10.1016/s0272-6386(12)80859-6
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发表时间：
1993-04-01
影响因子：
13.2
通讯作者：
ESUNGE, P
中科院分区：
文献类型：
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作者：
FLACK, JM;NEATON, JD;ESUNGE, P
高血压，特别是严重的高血压，已被证明是肾脏疾病的危险因素。血压（BP）和高肾病之间的关系是否存在于广泛的BP水平范围内尚不清楚。与白人相比，黑人因多种原因（包括高血压）而患终末期肾病的比率较高，在年轻年龄组中最为突出。为了检查跨越“正常”至“升高”范围的BP之间肾脏疾病的种族模式，总结了来自三项大型研究的数据：（1）347，978名男性的12年死亡率（22，471黑色和325，507例白色患者），既往无心肌梗死（MI），接受多风险因素干预试验（MRFIT）筛选平均随访12年的原因特异性死亡率，（2）5，524例高血压男性的基线和6年肾功能变化（463例黑人和5，061例白色）在MRFIT中随机分组，和（3）在轻度高血压治疗研究（TOMHS）中，比较902名患有轻度高血压的黑人和白色男性和女性（177名黑人和725名白色）的肌酐水平的基线和1年变化。在MRFIT筛选中，在黑人和白色男性中，即使在“正常范围”内，高血压水平下肾死亡风险也呈单调增加。在MRFIT和TOMHS中，黑人的基线肌酐水平较高。在MRFIT高血压患者中，6年肌酐变化可预测冠心病和全因死亡率，而基线肌酐水平不能预测。在MRFIT或TOMHS中，随机分组的比较未显示肾功能改善与更积极的BP降低，但在MRFIT中，平均治疗时DBP < 95 mm Hg与肌酐倒数的更有利斜率相关。1年时，在TOMHS中未观察到肌酐变化的性别特异性种族差异。在MRFIT高血压男性中，白色男性的6年肌酐变化略优于黑人男性（-0.088 μmol/L v +3.09 μmol/L，P= 0.004）。这些数据表明：（1）在黑人和白人中，血压和肾脏疾病之间存在分级和连续的关系，血压范围很广;（2）肌酐变化可预测随后的死亡率，至少在接受以利尿剂为基础的药物治疗方案的高血压男性中是如此;（3）黑人和白人中，抗高血压药物治疗后肌酐变化的模式可能不同。
Hypertension, particularly severe hypertension, has proven to be a risk factor for renal disease. Whether the relationship of blood pressure (BP) and high renal disease exists across a wide range of BP levels has been less clear. Compared with whites, blacks have a higher rate of end-stage renal disease from a multiplicity of causes, including hypertension, most prominently in younger age groups. To examine ethnic patterns of renal disease across BPs spanning the range of “normal” to “elevated,” data were summarized from three large studies: (1) 12-year mortality for the 347,978 men (22,471 black and 325,507 white) without prior myocardia infarction (MI) screened for the Multiple Risk Factor Intervention Trial (MRFIT) who have been followed an average of 12 years for cause-specific mortality, (2) the baseline and 6-year change in renal function in 5,524 hypertensive men (463 black and 5,061 white) randomized in the MRFIT, and (3) the baseline and 1-year change in creatinine level are compared in 902 black and white men and women (177 black and 725 white) with mild hypertension in the Treatment of Mild Hypertension Study (TOMHS). In the MRFIT screenees, there was a monotonic increase in the risk of renal mortality at higher BP levels, even within the “normal range,” both in black and white men. Blacks had higher baseline creatinine levels in both the MRFIT and TOMHS. In the MRFIT hypertensive patients, 6-year change in creatinine predicts coronary heart disease and all-cause mortality while the baseline creatinine level did not. Comparisons of randomized groups in the MRFIT or TOMHS did not demonstrate improved renal function with more aggressive BP lowering, but in MRFIT average on-treatment DBP < 95 mm Hg was associated with more favorable slopes of reciprocal creatinine. At 1 year, no gender-specific ethnic differences in creatinine change were observed in TOMHS. In the MRFIT hypertensive men, 6-year creatinine change was slightly more favorable in white men than in black men (-0.088 μmol/L v +3.09 μmol/L,P= 0.004). These data demonstrate (1) a graded and continuous relationship between BP and renal disease in blacks and whites across a wide BP range, (2) that creatinine change predicts subsequent mortality, at least in hypertensive men treated with diuretic-based pharmacologic regimen, and (3) possibly different pattern of creatinine change in response to antihypertensive drug therapy in blacks and whites.