解放军医学杂志2024，Vol.49Issue(6)：663-669,7.DOI:10.11855/j.issn.0577-7402.0801.2023.1221
不同血压分层对糖尿病人群肾功能的影响
Effect of different blood pressure stratification on renal function in diabetic population
陈永刚 1刘业强 2张艳敏 3吴寿岭 4张金凤 5陈朔华 4王丽文 1杨凯 1熊海亮 1高明 1姜春宇3
作者信息
- 1. 唐山中心医院心内科,河北唐山 063000
- 2. 唐山中心医院内分泌科,河北唐山 063000
- 3. 唐山中心医院消化内科,河北唐山 063000
- 4. 唐山开滦总医院心内科,河北唐山 063000
- 5. 唐山中心医院导管室,河北唐山 063000
- 折叠
摘要
Abstract
Objective To investigate the effect of varying blood pressure stratification on renal function in the diabetic population.Methods A prospective cohort study was conducted,enrolling 9 489 diabetic patients from a total of 101 510 Kailuan Group employees who underwent health examinations between July 2006 and October 2007.The follow-up period was(8.6±4.0)years.Participants were categorized into four groups based on their baseline blood pressure levels:normal blood pressure(systolic blood pressure<120 mmHg and diastolic blood pressure<80 mmHg),elevated blood pressure(systolic blood pressure 120-130 mmHg and diastolic blood pressure<80 mmHg),stage 1 hypertension(systolic blood pressure 130-140 mmHg and/or diastolic blood pressure 80-90 mmHg),and stage 2 hypertension(systolic blood pressure≥140 mmHg and/or diastolic blood pressure≥90 mmHg).The incidence density of chronic kidney disease(CKD)was compared among these groups.A multivariate Cox proportional hazards regression model was employed to assess the effects of different blood pressure levels on renal function in diabetic patients,with the stability of the results confirmed using a multivariate time-dependent Cox proportional hazards model.Sensitivity analysis was conducted after excluding cases of cardiovascular disease(CVD)during follow-up,and cases using antihypertensive and antidiabetic medications at baseline.Results(1)At baseline,stage 1 hypertension patients demonstrated statistically significant higher differences with age and body mass index(BMI)compared to normal blood pressure group(P<0.05).(2)By the end of the follow-up,2 294 cases of CKD were identified,including 1 117 cases of estimated glomerular filtration rate(eGFR)decline and 1 575 cases of urinary protein.The incidences density of CKD,eGFR decline and urinary protein for stage 1 hypertension group were 39.4,16.3 and 25.5 per thousand person-years,respectively,all of which were statistically significant different from normal blood pressure group(log-rank test,P<0.01).(3)Multivariate Cox regression analysis revealed that,compared to the normal blood pressure group,stage 1 hypertension was associated with a 29%increased risk of CKD(HR=1.29,95%CI 1.09-1.52)and a 40%increased risk of eGFR decline(HR=1.40,95%CI 1.08-1.80)in diabetic individuals.Conclusion Stage 1 hypertension significantly increases the risk of CKD and eGFR decline in diabetic individuals,with a particularly notable effect on the risk of eGFR decline.关键词
糖尿病/高血压1级/肾损伤/估算肾小球滤过率/尿蛋白Key words
diabetes/stage 1 hypertension/renal impairment/estimated glomerular filtration rate/urine protein detection分类
医药卫生引用本文复制引用
陈永刚,刘业强,张艳敏,吴寿岭,张金凤,陈朔华,王丽文,杨凯,熊海亮,高明,姜春宇..不同血压分层对糖尿病人群肾功能的影响[J].解放军医学杂志,2024,49(6):663-669,7.
