Circulation:对于脑血管疾病患者,强化降压会导致肾功能衰退(附评论)

2016-01-18 MedSci译 MedSci原创

目前强化降血压(BP)对于脑血管疾病的人中肾功能和估计肾小球滤过率(eGFR)的效果是未知的。在2610名随机降低(<130mmHg)与升高(130-149mmHg)SBP目标的参与者中,血肌酐被重复测量,研究人员分别采用线性混合模型和逻辑回归评估了每年eGFR下降率和迅速下降的差异(eGFR下降>30%)。研究人员使用多变量Cox回归评估了治疗和肾功能衰退与中风,主要血管事件(MVE

目前,在脑血管疾病的患者中,强化降压对肾功能和估计肾小球滤过率(eGFR)的影响是未知的。

在2610名随机降压患者中,目标分别为较低收缩压(<130mmHg)vs.较高收缩压(130-149mmHg),血肌酐被重复测量,研究人员分别采用线性混合模型和逻辑回归评估了每年eGFR下降率和迅速下降的差异(eGFR下降>30%)。研究人员使用多变量Cox回归评估了治疗和肾功能衰退与中风、主要血管事件(MVE)、复合中风、死亡、MVE或心肌梗死的关联,独立和联合的测试包括相互作用检验。分析经过治疗组进行。参与者平均年龄为63±11岁;949例(36%)患有糖尿病,平均的eGFR为80±19ml/min/1.73m2。在9个月时,在较高的和较低的BP组SBP分别137±15mmHg、127±14mmHg,差异在整个随访过程(平均3.2年)中一直保持。与较高的BP相比,较低的BP目标的eGFR下降要快-0.50(95%Cl - 0.79至-0.21)ml/min/1.73m2。差异在第一年时尤为明显(-2.1ml/min/1.73m2(95%Cl为-0.97至-3.2)),而eGFR的下降率在1年后没有差异(-0.095,-0.47至0.23)。在BP较低的组共有313(24%)人有快速的肾功能衰退,在较高的BP组有247人(19%)(OR 1.4(95%Cl为1.1至1.6))。迅速下降的差异,在治疗组中在第一年很明显(OR 1.4,1.1至1.8),但在1年后差异不显著(OR 1.0,0.73至1.4)。在随机分配到较高的BP目标的人中,充分调整之后,迅速下降与中风、MVE和复合终点的高风险相关(即中风 HR 1.93[1.15至3.21],但较低的BP组不是这样,中风HR 0.93[0.50至1.75])(所有P<0.06)。

在腔隙性卒中既往史且相对保存肾功能的患者中,强化降压治疗会导致快速肾功能衰退的可能性将非常大。差异主要在抗高血压治疗的第一年中能够观察到。快速肾功能衰退与正在进行强化降低血压患者的临床事件风险增加无关。

MedSci简评:

SPRINT研究结果让我们认识到强化降压可能带来心血管事件和死亡的风险减轻,然而在特殊人群,我们还需要更多的证据支持,例如对于老年患者,或伴有肾功能不全的患者,或伴有轻度认知障碍的患者,能否参照SPRINT结果进行强化降压,这是值得商榷的。强化降压会不会带来器官灌注的减少,从而加重某些器官病变或加速病变的进程,如老年性痴呆,肾功能损害等。下一步需要更全面的,严谨的证据进行论证。


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time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497952, encodeId=b77d149e95250, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58318, encodeId=840558318f4, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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    2016-06-29 yese
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    2016-01-26 doctording1

    是一篇不错的文章哈

    0

  4. 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createdName=hmwwww, createdTime=Wed Mar 23 09:18:00 CST 2016, time=2016-03-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59652, encodeId=4dfc5965212, content=是一篇不错的文章哈, beContent=null, objectType=article, channel=null, level=null, likeNumber=148, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 16:35:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59650, encodeId=14b65965021, content=这篇文章有一定深度, beContent=null, objectType=article, channel=null, level=null, likeNumber=147, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59121683644, createdName=doctording1, createdTime=Tue Jan 26 16:35:00 CST 2016, time=2016-01-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=59471, 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href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1428740, encodeId=4e5a1428e4012, content=<a href='/topic/show?id=c9ae85106df' target=_blank style='color:#2F92EE;'>#脑血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85106, encryptionId=c9ae85106df, topicName=脑血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13c94134529, createdName=lfyang, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497952, encodeId=b77d149e95250, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58318, encodeId=840558318f4, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Tue Jan 19 06:51:00 CST 2016, time=2016-01-19, status=1, ipAttribution=)]
    2016-01-26 doctording1

    这篇文章有一定深度

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1850570, encodeId=31d118505e00e, content=<a href='/topic/show?id=46c682469e4' target=_blank style='color:#2F92EE;'>#肾功能#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=82469, encryptionId=46c682469e4, topicName=肾功能)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28d456, createdName=yese, createdTime=Wed Jun 29 04:18:00 CST 2016, time=2016-06-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1798949, encodeId=68ea1e989496b, content=<a href='/topic/show?id=38e0e0670ff' target=_blank style='color:#2F92EE;'>#疾病患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=91, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70670, encryptionId=38e0e0670ff, topicName=疾病患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c859411, 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href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1428740, encodeId=4e5a1428e4012, content=<a href='/topic/show?id=c9ae85106df' target=_blank style='color:#2F92EE;'>#脑血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85106, encryptionId=c9ae85106df, topicName=脑血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13c94134529, createdName=lfyang, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497952, encodeId=b77d149e95250, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58318, encodeId=840558318f4, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Tue Jan 19 06:51:00 CST 2016, time=2016-01-19, status=1, ipAttribution=)]
    2016-01-26 doctording1

    这个值得关注

    0

  6. 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href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1428740, encodeId=4e5a1428e4012, content=<a href='/topic/show?id=c9ae85106df' target=_blank style='color:#2F92EE;'>#脑血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85106, encryptionId=c9ae85106df, topicName=脑血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13c94134529, createdName=lfyang, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497952, encodeId=b77d149e95250, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58318, encodeId=840558318f4, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Tue Jan 19 06:51:00 CST 2016, time=2016-01-19, status=1, ipAttribution=)]
  7. 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href='/topic/show?id=e051501461d' target=_blank style='color:#2F92EE;'>#强化降压#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50146, encryptionId=e051501461d, topicName=强化降压)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=2c6c3470765, createdName=fengxx, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1428740, encodeId=4e5a1428e4012, content=<a href='/topic/show?id=c9ae85106df' target=_blank style='color:#2F92EE;'>#脑血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=88, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85106, encryptionId=c9ae85106df, topicName=脑血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=13c94134529, createdName=lfyang, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1497952, encodeId=b77d149e95250, content=<a href='/topic/show?id=bb6f89e145a' target=_blank style='color:#2F92EE;'>#血管疾病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=83, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89714, encryptionId=bb6f89e145a, topicName=血管疾病)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ccb99370406, createdName=andy2090, createdTime=Wed Jan 20 12:18:00 CST 2016, time=2016-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=58318, encodeId=840558318f4, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=154, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Tue Jan 19 06:51:00 CST 2016, time=2016-01-19, status=1, ipAttribution=)]
  8. 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  9. 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    2016-01-19 wzf990214

    0

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