抗高血压治疗后肌酐水平升高对患者心血管事件发生率的影响研究

胡芳英; 方红薇; 林萍; 张秋实; 马静; 陈月芳

doi:10.16766/j.cnki.issn.1674-4152.002544

抗高血压治疗后肌酐水平升高对患者心血管事件发生率的影响研究

doi: 10.16766/j.cnki.issn.1674-4152.002544

1.
杭州市第三人民医院老年医学科，浙江杭州 310009
2.
杭州市第三人民医院心内科，浙江杭州 310009
3.
杭州市第三人民医院皮肤科，浙江杭州 310009

基金项目:

浙江省医药卫生计划B类项目 2020KY724

详细信息

通讯作者:
方红薇, E-mail: fanghongwei1974@126.com

中图分类号: R544.1
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出版历程
- 收稿日期: 2021-09-01
- 网络出版日期: 2022-09-23

Study on the effect of increased creatinine level after antihypertensive treatment on the risk of cardiovascular events in patients

1.
Department of Geriatrics, Hangzhou Third People's Hospital, Hangzhou, Zhejiang 310009, China

摘要

摘要: 目的抗高血压治疗中肾素-血管紧张素抑制剂伴随的肾功能下降与心血管疾病的发生率升高相关，但其他降压药相关的研究仍较少。本文旨在探究采用一线抗高血压药物治疗后血浆肌酐升高对相关心血管事件发生率的影响。方法纳入2015年10月—2020年6月至杭州市第三人民医院就诊的高血压患者182例，男性96例，女性86例，年龄为(60.5±6.4)岁。所有患者在此时间段内接受肾素-血管紧张素抑制剂、钙通道阻滞剂或噻嗪类抗高血压药物治疗。通过治疗前基线肌酐水平及最近一次(≤90 d)的测量值计算血浆肌酐升高的百分比，探究6个月心血管事件(缺血性心肌病、心力衰竭或和脑卒中)的发生率与肌酐升高的相关性。结果按照肌酐水平进行分组，分别为A组(0%~9%，79例)、B组(10%~19%，40例)、C组(20%~29%，27例)、D组(30%~39%，20例)、E组(>40%，16例)，43.4%(79/182)的患者肌酐升高水平在0%~9%。在随访6个月时间内总计发生心血管事件6例(3.3%)，无死亡患者。肌酐升高0%~9%和30%~39%相应的6个月心血管事件发生率分别为0%和1.1%。总随访时间为3.1(1.8, 5.8)年，整体心血管事件发生率为8.2%(15/182)，D组和E组的发生率显著高于其他组(P＜0.001)。较高的年龄、肾功能降低和相应的抗高血压药物均与心血管事件的发生率密切相关。结论初级预防中开始一线抗高血压治疗的患者血浆肌酐水平升高30%以上与近期(6个月)及远期(3年)的心血管事件发生率升高相关。
- 抗高血压治疗 /
- 高血压 /
- 肌酐 /
- 心血管事件
Abstract: Objective Decreased renal function associated with renin-angiotensin inhibitors in antihypertensive therapy is associated with an increased risk of cardiovascular disease. However, few studies on other antihypertensive drugs are available. This study aimed to investigate the incidence of cardiovascular events associated with elevated plasma creatinine following first-line antihypertensive medication. Methods A total of 182 patients with hypertension who visited Hangzhou Third People's Hospital from October 2015 to June 2020 were enrolled, including 96 males and 86 females, aged (60.5±6.4) years. All patients received renin-angiotensin inhibitors, calcium channel blockers or thiazide antihypertensives during this time period. The correlation between the incidence of 6-month cardiovascular events (ischemic cardiomyopathy, heart failure or stroke) and elevated creatinine was explored. Results In accordance with creatinine level, the patients were divided into group A (0%-9%, 79 cases), group B (10%-19%, 40 cases), group C (20%-29%, 27 cases), group D (30%-39%, 20 cases) and group E (>40%, 16 cases). Amongst them, 43.4% (79/182) of patients had an elevated creatinine level of 0%-9%. Six cardiovascular events (3.3%) occurred during the 6-month follow-up period, and no patient died. The creatinine elevations of 0%-9% and 30%-39% corresponded to 6-month cardiovascular event rates of 0.6% and 3.4%, respectively. The total follow-up time was 3.1 (1.8, 5.8) years, the overall incidence of cardiovascular events was 8.2% (15/182) and the incidence in groups D and E was significantly higher than that in other groups (P < 0.001). Higher age and reduced renal function were strongly associated with increased odds of cardiovascular events but not with type of antihypertensive medication. Conclusion A greater than 30% increase in plasma creatinine levels in patients starting first-line antihypertensive therapy in primary prevention is associated with increased short-term (6 months) and long-term (3 years) incidence of cardiovascular events.
- Antihypertensive therapy /
- Hypertension /
- Creatinine /
- Cardiovascular events

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图 1 各组高血压患者第2次肌酐测量后3年心血管事件累积发生率

Figure 1. Cumulative incidence of cardiovascular events 3 years after the second creatinine measurement in hypertensive patients in each group

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表 1 各组高血压患者的基本特征比较[例(%)]

Table 1. Comparison of basic characteristics of hypertensive patients in each group [cases(%)]

组别	例数	性别		eGFR≥60 mL/(min·1.73 m²)		ACR			抗高血压药物
组别	例数	男性	女性	eGFR≥60 mL/(min·1.73 m²)		＜30	30~300	＞300	ARBs	CCB	噻嗪类
整体	182	96(52.7)	86(47.3)	175(96.2)		125(68.7)	40(22.0)	17(9.3)	130(71.4)	22(12.1)	30(16.5)
A组	79	41(51.9)	38(48.1)	76(96.2)		55(69.6)	17(21.5)	7(8.8)	62(78.5)	9(11.4)	8(10.1)
B组	40	21(52.5)	19(47.5)	39(97.5)		28(70.0)	8(20.0)	4(10.0)	30(75.0)	4(10.0)	6(15.0)
C组	27	14(51.9)	13(48.1)	26(96.3)		18(66.7)	6(22.2)	3(11.1)	17(63.0)	4(14.8)	6(22.2)
D组	20	11(55.0)	9(45.0)	19(98.5)		13(65.0)	5(25.0)	2(10.0)	12(60.0)	3(15.0)	5(25.0)
E组	16	9(56.3)	7(43.7)	15(93.8)		11(68.8)	4(25.0)	1(6.3)	9(56.3)	2(12.5)	5(31.3)
统计量		0.558^a		1.151^a		15.332^b			3.544^a
P值		0.071		0.222		0.206			＜0.001

组别	例数	糖尿病		HbA1c					总胆固醇		COPD
组别	例数	糖尿病		正常水平	高于正常水平	显著高水平	低水平		＜5 mmol/L	≥5 mmol/L	COPD
整体	182	27(14.8)		114(62.6)	35(19.2)	20(11.0)	13(7.1)		64(35.2)	118(64.8)	8(4.4)
A组	79	10(12.7)		50(63.3)	15(19.0)	8(10.1)	6(7.6)		28(35.4)	51(64.6)	3(3.8)
B组	40	6(15.0)		24(60.0)	8(20.0)	5(12.5)	3(7.5)		14(35.0)	26(65.0)	2(5.0)
C组	27	4(14.8)		17(63.0)	5(18.5)	3(11.1)	2(7.4)		9(33.3)	18(66.7)	1(3.7)
D组	20	4(20.0)		13(65.0)	4(20.0)	2(10.0)	1(5.0)		7(35.0)	13(65.0)	1(5.0)
E组	16	3(18.8)		10(62.5)	3(18.8)	2(12.5)	1(6.3)		6(37.5)	10(62.5)	1(6.3)
统计量		0.281^a		20.357^b					2.882^a		0.551^a
P值		0.381		＜0.001					0.188		0.174
注：^a为χ²值，^b为H值。

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表 2 各组高血压患者6个月心血管事件发生率比较(%)

Table 2. Comparison of 6-month cardiovascular events in patients with hypertension in each group(%)

组别	例数	性别		年龄(岁)			eGFR[mL/(min·1.73 m²)]		抗高血压药物
组别	例数	男性	女性	18~49	50~79	≥80	＜60	≥60	CCB	ARBs	噻嗪类
A组	79	1.4	1.0	0.6	1.3	2.1	4.0	1.3	1.4	1.3	1.4
B组	40	1.7	1.2	0.8	1.8	2.8	5.0	1.9	1.8	1.6	1.7
C组	27	1.5	1.1	0.5	1.5	2.4	4.3	1.5	1.6	1.5	1.6
D组	20	3.5	2.9	1.3	3.8	6.1	10.5	3.7	4.0	3.6	3.2
E组	16	4.6	3.0	1.4	4.5	7.1	12.5	4.6	5.0	4.5	4.3
统计量		3.215^a		3.250^b			6.446^a		4.445^a
P值		＜0.001		＜0.001			＜0.001		＜0.001
注：^a为χ²值，^b为H值。

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