The influence of blood pressure patterns on renal outcomes in patients with chronic kidney disease The long-term follow up result of the APrODiTe-2 study

被引：12

作者：

Cha, Ran-hui ^{[1
]}

Lee, Hajeong ^{[2
]}

Lee, Jung Pyo ^{[3
]}

Kim, Yon Su ^{[2
,4
]}

Kim, Sung Gyun ^{[5
]}

机构：

[1] Natl Med Ctr, Dept Internal Med, Seoul, South Korea

[2] Seoul Natl Univ, Dept Internal Med, Coll Med, Seoul, South Korea

[3] Seoul Natl Univ, Dept Internal Med, Boramae Med Ctr, Seoul, South Korea

[4] Seoul Natl Univ, Kidney Res Inst, Med Res Ctr, Seoul, Seoul, South Korea

[5] Hallym Univ, Dept Internal Med, Sacred Heart Hosp, Anyang, South Korea

来源：

MEDICINE | 2020年 / 99卷 / 08期

关键词：

blood pressure; chronic kidney disease; long-term; renal complication; target organ damage; TARGET ORGAN DAMAGE; HYPERTENSION; ASSOCIATION; RISK; HOME; HEMODIALYSIS; PROGRESSION; TRIAL;

D O I：

10.1097/MD.0000000000019209

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Blood pressure (BP) control is the most established practice for preventing the progression and complications of chronic kidney disease (CKD). We examined the influence of BP patterns on target organ damage in hypertensive patients with CKD by using long-term follow-up data of the APrODiTe-2 study. We collected 5 years of data of APrODiTe-2 study (1 year longitudinal study) participants after the enrollment on the progression of estimated glomerular filtration (eGFR), renal outcomes (doubling of serum creatinine, 50% decrease of eGFR, maintenance dialysis, and kidney transplantation), cerebro-cardiovascular (CCV) accidents, and all-cause mortality (n=378) to evaluate the long-term influence of BP patterns on target organ damages. Initially, more than 2/3 of patients showed masked (50.0%) and sustained uncontrolled (30.6%) BP control states as well as non- (31.3%) and reverse-dipping (35.0%) states. Only 18.8% and 20.8% of participants showed a better change in BP control patterns and a dipping pattern change to dippers over 1 year, respectively. Composite of new CCV accidents occurred in 43 patients (11.4%), and no BP patterns were associated with the occurrence of new CCV accidents. A worse change in BP control categories over 1 year was associated with increased occurrence of composites of renal outcomes after adjustment for age, sex, and the cause of CKD (HR 5.997 [1.454-24.742], P = .013 and HR 4.331 [1.347-13.927], P = .014, respectively). Patients with a worse initial BP control category, a worse change in BP control categories over 1 year, and higher clinic systolic BP and pulse pressure (PP) (> median level) were more likely to have faster eGFR progression (absolute eGFR and eGFR ratio). Higher BP burden (a worse change in BP control categories, higher initial clinic systolic BP and PP) was associated with faster eGFR progression and increased occurrence of renal outcomes.

引用

页数：7

共 35 条

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