日本學者近期對家庭和診室血壓水平與接受治療高血壓患者的腎功能進一步降低的相關性進行了研究。相關論文近期發表於《高血壓研究》(Hypertens Res.)雜誌。
研究者們計算了1535例接受家庭和診室血壓監測並進行治療的高血壓患者的估算腎小球濾過率年變化(ΔeGFR)。以1.5年隨訪期間患者ΔeGFR<0定義為腎功能下降，ΔeGFR⩾0定義為腎功能不下降。
結果顯示，在520例基線低水平的eGFR患者中，家庭晨間、夜晚和診室收縮壓水平，以及晨間家庭舒張壓水平與腎功能下降風險呈正相關關係(P趨勢分別為0.003、 0.002、0.003和0.004)。
與家庭收縮壓<125 mm Hg 的患者相比，家庭收縮壓在125-130 mm Hg之間的患者腎功能下降風險與其相似;而家庭收縮壓⩾135 mm Hg 和在130-135 mm Hg之間的患者腎功能下降風險較高。
在基線eGFR正常的1015例患者中，僅家庭晨間收縮壓水平與腎功能下降風險呈正相關關係(P趨勢0.004)。
該研究表明，家庭晨間血壓或可用於評估腎功能正常且接受高血壓治療患者的腎功能下降風險。未來還需進一步研究這些高血壓患者的家庭血壓控製目標。
參考文獻：Ishikura K1,etal.Hypertens Res. 2015 Oct 29. doi: 10.1038/hr.2015.110. [Epub ahead of print]
Hypertens Res. 2015 Oct 29. doi: 10.1038/hr.2015.110. [Epub ahead of print]
Home blood pressure level and decline in renal function among treated hypertensive patients: the J-HOME-Morning Study.
Ishikura K1, Obara T2,3,4, Kikuya M2,3, Satoh M3, Hosaka M1, Metoki H4,5, Nishigori H5, Mano N3, Nakayama M6, Imai Y1, Ohkubo T7.
Author information:
• 1Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
• 2Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
• 3Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan.
• 4Tohoku University Tohoku Medical Megabank Organization, Sendai, Japan.
• 5Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.
• 6Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
• 7Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Abstract
We examined the association between home and office blood pressure (BP) levels and further decline in renal function among treated hypertensive patients with and without renal dysfunction. We calculated annual decline in estimated glomerular filtration rate (ΔeGFR) in 1535 treated hypertensive patients with home and office BP measurements.We defined ΔeGFR<0 as decline in renal function, and ΔeGFR⩾0 as non-decline in renal function based on 1.5 years of follow-up.For 520 patients with low eGFR at baseline, morning home, evening home and office systolic BP (SBP) levels and morning home diastolic BP (DBP) levels were positively associated with the risk of decline in renal function (trend P=0.003, 0.002, 0.003 and 0.004). Compared to patients with home SBP <125 mm Hg,the risk of decline in renal function was higher in those with home SBPs ⩾135 mm Hg and between 130-135 mm Hg, while the risk was similar in those with home SBP of 125-130 mm Hg.For 1015 patients with normal eGFR at baseline,only morning home SBP level was positively associated with the risk of decline in renal function (trend P=0.004).Morning home BP might be useful for risk evaluation of decline in renal function even among treated hypertensive patients with normal renal function.Target levels of home BP control among treated hypertensive patients need to be further investigated.Hypertension Research advance online publication, 29 October 2015; doi:10.1038/hr.2015.110.
