高血压合并蛋白尿患者的收缩压和保留的肾功能。VALUE试验。

IF 2.3 4区医学

Blood Pressure Pub Date : 2025-12-01 Epub Date: 2025-08-19 DOI:10.1080/08037051.2025.2544715

Eirik Olsen, Julian E Mariampillai, Roland E Schmieder, Kenneth Jamerson, Camilla L Søraas, Giuseppe Mancia, Maria H Mehlum, Knut Liestøl, Anne C K Larstorp, Lene V Halvorsen, Bård Waldum-Grevbo, Rune Mo, Sverre E Kjeldsen, Michael A Weber

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引用次数: 0

摘要

目的：我们研究治疗后收缩压（SBP）方法和结果：肾功能恶化（WKF）血清肌酐升高≥50%，终末期肾病（ESKD）透析/移植。对未接受治疗的收缩压组的Cox比例风险模型进行协变量校正。较低的收缩压与较低的WKF显著相关（p与蛋白尿均为无蛋白尿），当蛋白尿和ESKD从3.5%（第一季度）降至1.6%（第二季度）（p = 0.13）、0.7%（第三季度）（p = 0.027）和0.1%（第四季度）时，较低的收缩压和WKF之间的关系不显著（p = 0.23）。在没有蛋白尿的患者中，WKF和ESKD在收缩压四分位数之间没有统计学上的显著变化。结论：我们的数据表明，与收缩压≥140 mmHg相比，治疗后的收缩压

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On-treatment systolic blood pressure and preserved kidney function in hypertensive patients with proteinuria. The VALUE Trial.

Aims: We investigated on-treatment systolic BP (SBP) <130, 130-139 and ≥140 mmHg related to nephroprotection in 3065 patients with proteinuria and 10,738 patients without proteinuria in the VALUE Trial.

Method and results: Worsened kidney function (WKF) was ≥50% increase in serum creatinine, and end-stage kidney disease (ESKD) was dialysis/transplantation. Cox proportional hazards models were adjusted for covariates in the on-treatment SBP groups. Lower SBP was significantly related to less WKF (p < .001) in patients with proteinuria, both at <130 mmHg (n = 14/529, 2.6%) and 130-139 mmHg (n = 46/1176, 3.9%) compared to ≥140 mmHg (n = 145/1358, 10.7%). None of the 532 patients with proteinuria had ESKD at <130 mmHg, and only 11/1194 (0.9%) at 130-139 mmHg (p = .098) compared to 39/1339 (2.9%) at SBP ≥ 140 mmHg. In patients without proteinuria the relation between lower SBP and WKF was not significant (p = .23) at <130 mmHg (n = 24/1927, 1.2%) but significant (p = .04) at 130-139 mmHg (n = 74/4611, 1.6%) compared to SBP ≥ 140 mmHg (n = 117/4199, 2.8%). ESKD was 0.2%, 0.2% and 0.4% in the SBP groups, respectively. WKF fell from 12.1% in Q1 (highest SBP quartile) to 6.1% in Q2 (p = .023), 4.2% in Q3 (p = .006) and 2.8% in Q4 (p < .001) in patients with proteinuria and ESKD from 3.5% (Q1) to 1.6% (Q2) (p = .13), 0.7% (Q3) (p = .027) and 0.1% in Q4 (p = .009). In the patients without proteinuria, neither WKF nor ESKD showed statistically significant changes between SBP quartiles.

Conclusions: Our data suggest that, compared to SBP ≥ 140 mmHg, on-treatment SBP <130 and 130-139 mmHg were strongly related to nephroprotection in hypertensive patients with proteinuria.

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来源期刊

Blood Pressure Medicine-Cardiology and Cardiovascular Medicine

CiteScore

3.20

自引率

5.60%

发文量

期刊介绍： For outstanding coverage of the latest advances in hypertension research, turn to Blood Pressure, a primary source for authoritative and timely information on all aspects of hypertension research and management. Features include: • Physiology and pathophysiology of blood pressure regulation • Primary and secondary hypertension • Cerebrovascular and cardiovascular complications of hypertension • Detection, treatment and follow-up of hypertension • Non pharmacological and pharmacological management • Large outcome trials in hypertension.