慢性肾脏病患者的炎症和明显的难治性高血压,Hypertension

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慢性肾脏病患者的炎症和明显的难治性高血压
Hypertension ( IF 6.9 ) Pub Date : 2019-04-01 , DOI: 10.1161/hypertensionaha.118.12358
Jing Chen _{1,

2,

3} , Joshua D Bundy _{2,

4} , L Lee Hamm _{1,

2,

3} , Chi-Yuan Hsu ₅ , James Lash ₆ , Edgar R Miller ₇ , George Thomas ₈ , Debbie L Cohen ₉ , Matthew R Weir ₁₀ , Dominic S Raj ₁₁ , Hsiang-Yu Chen ₁₂ , Dawei Xie ₁₂ , Panduranga Rao ₁₃ , Jackson T Wright ₁₄ , Mahboob Rahman ₁₄ , Jiang He _{1,

2,

3}

Affiliation

From the Department of Medicine (J.C., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.
Department of Epidemiology (J.C., J.D.B., L.L.H., J.H.), Tulane University School of Medicine, New Orleans, LA.
Tulane University Translational Science Institute, New Orleans, LA (J.C., L.L.H., J.H.).
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (J.D.B.).
Department of Medicine, University of California San Francisco School of Medicine, CA (C.-y.H.).
Department of Medicine, University of Illinois College of Medicine, Chicago (J.L.).
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (E.R.M.).
Department of Nephrology and Hypertension, Cleveland Clinic, OH (G.T.).
Department of Medicine (D.L.C.), University of Pennsylvania Perelman School of Medicine, Philadelphia.
Department of Medicine, University of Maryland School of Medicine, Baltimore (M.R.W.).
Department of Medicine, Georgetown University School of Medicine, Washington, DC (D.S.R.).
Department of Biostatistics, Epidemiology, and Informatics (H.-y.C., D.X.), University of Pennsylvania Perelman School of Medicine, Philadelphia.
Department of Medicine, University of Michigan School of Medicine, Ann Arbor (P.R.).
Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (J.T.W., M.R.).

表观难治性高血压 (ATRH) 在慢性肾病患者中非常普遍，并且与心血管疾病风险相关。我们分析了炎症生物标志物与 ATRH 及其并发症在慢性肾病患者中的关联。ATRH 定义为服用≥3 种抗高血压药物时血压≥140/90 mmHg 或服用≥4 种药物时血压<140/90 mmHg。分析包括 1359 名有 ATRH 的 CRIC 研究（慢性肾功能不全队列）参与者和 2008 名没有 ATRH 的高血压参与者。Logistic 回归用于检查炎症生物标志物和 ATRH 的横断面关联，调整人口统计学、生活方式、临床危险因素和治疗。Cox 比例风险模型用于评估炎症生物标志物对 ATRH 与复合心血管疾病和死亡率相关性的影响，超出常规风险因素。对于 IL（白细胞介素）-6，ATRH 最高三分位数与最低三分位数炎症生物标志物水平的多变量调整比值比（95% CI）为 1.29（95% CI，1.05-1.59）-6，1.49（95% CI，1.20） –1.85) 对于 TNF-&agr; (肿瘤坏死因子-&agr;)，TGF-&bgr 为 0.77 (95% CI，0.63-0.95)。(转化生长因子-&bgr;)。高敏 CRP（C 反应蛋白）、纤维蛋白原、IL-1&bgr; 和 IL-1 受体拮抗剂与 ATRH 没有显着相关性。将炎症生物标志物添加到 Cox 模型并没有减弱 ATRH 与心血管疾病和死亡率的显着关联。我们的研究结果表明 IL-6 和 TNF-α 水平较高。和较低水平的 TGF-&bgr; 与 ATRH 的几率独立相关。针对特定炎症通路可能会改善慢性肾病患者的血压控制。

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Inflammation and Apparent Treatment-Resistant Hypertension in Patients With Chronic Kidney Disease

Apparent treatment-resistant hypertension (ATRH) is highly prevalent and associated with cardiovascular disease risk in patients with chronic kidney disease. We analyzed the association of inflammatory biomarkers with ATRH and its complications in patients with chronic kidney disease. ATRH was defined as blood pressure ≥140/90 mm Hg while taking ≥3 antihypertensive medications or blood pressure <140/90 mm Hg while taking ≥4 medications. Analyses included 1359 CRIC study (Chronic Renal Insufficiency Cohort) participants with ATRH and 2008 hypertensive participants without. Logistic regression was used to examine cross-sectional associations of inflammatory biomarkers and ATRH adjusting for demographic, lifestyle, and clinical risk factors and treatments. Cox proportional hazards models were used to assess the impact of inflammatory biomarkers on associations of ATRH with composite cardiovascular disease and mortality beyond conventional risk factors. Multivariable-adjusted odds ratio (95% CI) of ATRH for the highest tertile versus the lowest tertile of inflammatory biomarker levels was 1.29 (95% CI, 1.05–1.59) for IL (interleukin)-6, 1.49 (95% CI, 1.20–1.85) for TNF-&agr; (tumor necrosis factor-&agr;), and 0.77 (95% CI, 0.63–0.95) for TGF-&bgr; (transforming growth factor-&bgr;). High-sensitivity CRP (C-reactive protein), fibrinogen, IL-1&bgr;, and IL-1 receptor antagonist were not significantly associated with ATRH. Adding inflammatory biomarkers to Cox models did not attenuate the significant association of ATRH with cardiovascular disease and mortality. Our findings show higher levels of IL-6 and TNF-&agr; and lower levels of TGF-&bgr; were independently associated with odds of ATRH. Targeting specific inflammatory pathways may improve blood pressure control in patients with chronic kidney disease.

更新日期：2019-04-01

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