Pulse Pressure and Cardiovascular and Kidney Outcomes by Age in the Chronic Renal Insufficiency Cohort (CRIC).

IF 3.2 3区医学 Q2 PERIPHERAL VASCULAR DISEASE

American Journal of Hypertension Pub Date : 2024-10-22 DOI:10.1093/ajh/hpae136

Clara J Fischman, Raymond R Townsend, Debbie L Cohen, Mahboob Rahman, Matthew R Weir, Stephen P Juraschek, Andrew M South, Lawrence J Appel, Paul Drawz, Jordana B Cohen

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引用次数: 0

Abstract

Background: Wide pulse pressure (PP) is associated with cardiovascular events and the progression of chronic kidney disease (CKD) to kidney failure. PP naturally widens with age, but it is unclear whether the risks associated with greater PP are the same across all ages.

Methods: We used Cox proportional hazards models to investigate the association of PP with (i) atherosclerotic cardiovascular disease (ASCVD) events or death and (ii) a 50% reduction in estimated glomerular filtration rate or kidney failure in the chronic renal insufficiency cohort (CRIC). We evaluated the association of time-updated PP with these outcomes, accounting for time-updated confounders using inverse probability weighting.

Results: Among 5,621 participants with CKD, every 10-mmHg greater PP was associated with a 6% higher risk of an ASCVD event or death (hazard ratio [HR] = 1.06, 95% CI 1.04, 1.08) and 17% higher risk of the composite kidney outcome (HR = 1.17, 95% CI 1.16, 1.18). Greater PP was associated with a higher risk of ASCVD events or death among participants in the lowest age tertile (21-61 years), but a higher risk of the composite kidney outcome in the oldest age tertile (71-79 years). While wide PP in participants that experienced the primary outcomes was predominantly driven by elevated SBP, PP remained significantly associated with the composite kidney outcome across all ages and with ASCVD events or death in the first age tertile when SBP was added to the Cox regression model.

Conclusions: Our findings suggest that the mechanism by which PP is associated with adverse outcomes may differ by age.

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慢性肾功能不全队列 (CRIC) 中按年龄划分的脉压与心血管和肾脏结果。

背景：宽脉压（PP）与心血管事件和慢性肾脏病（CKD）发展为肾衰竭有关。脉压会随着年龄的增长而自然增宽，但目前还不清楚脉压增宽所带来的风险是否在所有年龄段都相同：我们使用 Cox 比例危险模型研究了慢性肾功能不全队列（CRIC）中 PP 与（i）动脉粥样硬化性心血管疾病（ASCVD）事件或死亡以及（ii）估计肾小球滤过率降低 50%或肾衰竭的关系。我们使用反概率加权法考虑了时间更新的混杂因素，评估了时间更新的PP与这些结果的关联：在 5,621 名慢性肾脏病患者中，PP 每增加 10 mmHg，ASCVD 事件或死亡风险就会增加 6%（危险比 [HR] = 1.06，95% CI 1.04，1.08），肾脏综合结果风险增加 17%（HR = 1.17，95% CI 1.16，1.18）。在年龄最小的三等分组（21-61 岁）中，PP 越大，发生 ASCVD 事件或死亡的风险越高，但在年龄最大的三等分组（71-79 岁）中，发生肾脏综合结果的风险越高。虽然出现主要结局的参与者中广泛的PP主要是由SBP升高引起的，但当SBP被添加到Cox回归模型中时，PP与所有年龄段的综合肾脏结局以及第一个年龄三等分位组的ASCVD事件或死亡仍有显著相关性：我们的研究结果表明，PP与不良结局相关的机制可能因年龄而异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Hypertension 医学-外周血管病

CiteScore

6.90

自引率

6.20%

发文量

144

审稿时长

3-8 weeks

期刊介绍： The American Journal of Hypertension is a monthly, peer-reviewed journal that provides a forum for scientific inquiry of the highest standards in the field of hypertension and related cardiovascular disease. The journal publishes high-quality original research and review articles on basic sciences, molecular biology, clinical and experimental hypertension, cardiology, epidemiology, pediatric hypertension, endocrinology, neurophysiology, and nephrology.