日本学者近期对家庭和诊室血压水平与接受治疗高血压患者的肾功能进一步降低的相关性进行了研究。相关论文近期发表于《高血压研究》(Hypertens Res.)杂志。

        研究者们计算了1535例接受家庭和诊室血压监测并进行治疗的高血压患者的估算肾小球滤过率年变化(ΔeGFR)。以1.5年随访期间患者ΔeGFR<0定义为肾功能下降，ΔeGFR⩾0定义为肾功能不下降。

        结果显示，在520例基线低水平的eGFR患者中，家庭晨间、夜晚和诊室收缩压水平，以及晨间家庭舒张压水平与肾功能下降风险呈正相关关系(P趋势分别为0.003、 0.002、0.003和0.004)。

        与家庭收缩压<125 mm Hg 的患者相比，家庭收缩压在125-130 mm Hg之间的患者肾功能下降风险与其相似;而家庭收缩压⩾135 mm Hg 和在130-135 mm Hg之间的患者肾功能下降风险较高。

        在基线eGFR正常的1015例患者中，仅家庭晨间收缩压水平与肾功能下降风险呈正相关关系(P趋势0.004)。

        该研究表明，家庭晨间血压或可用于评估肾功能正常且接受高血压治疗患者的肾功能下降风险。未来还需进一步研究这些高血压患者的家庭血压控制目标。

        参考文献：Ishikura K1,etal.Hypertens Res. 2015 Oct 29. doi: 10.1038/hr.2015.110. [Epub ahead of print]

Hypertens Res. 2015 Oct 29. doi: 10.1038/hr.2015.110. [Epub ahead of print]
Home blood pressure level and decline in renal function among treated hypertensive patients: the J-HOME-Morning Study.
Ishikura K1, Obara T2,3,4, Kikuya M2,3, Satoh M3, Hosaka M1, Metoki H4,5, Nishigori H5, Mano N3, Nakayama M6, Imai Y1, Ohkubo T7.
Author information:
•  1Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan.
•  2Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Japan.
•  3Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan.
•  4Tohoku University Tohoku Medical Megabank Organization, Sendai, Japan.
•  5Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan.
•  6Department of Nephrology and Hypertension, Fukushima Medical University, Fukushima, Japan.
•  7Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan.
Abstract
We examined the association between home and office blood pressure (BP) levels and further decline in renal function among treated hypertensive patients with and without renal dysfunction. We calculated annual decline in estimated glomerular filtration rate (ΔeGFR) in 1535 treated hypertensive patients with home and office BP measurements.We defined ΔeGFR<0 as decline in renal function, and ΔeGFR⩾0 as non-decline in renal function based on 1.5 years of follow-up.For 520 patients with low eGFR at baseline, morning home, evening home and office systolic BP (SBP) levels and morning home diastolic BP (DBP) levels were positively associated with the risk of decline in renal function (trend P=0.003, 0.002, 0.003 and 0.004). Compared to patients with home SBP <125 mm Hg,the risk of decline in renal function was higher in those with home SBPs ⩾135 mm Hg and between 130-135 mm Hg, while the risk was similar in those with home SBP of 125-130 mm Hg.For 1015 patients with normal eGFR at baseline,only morning home SBP level was positively associated with the risk of decline in renal function (trend P=0.004).Morning home BP might be useful for risk evaluation of decline in renal function even among treated hypertensive patients with normal renal function.Target levels of home BP control among treated hypertensive patients need to be further investigated.Hypertension Research advance online publication, 29 October 2015; doi:10.1038/hr.2015.110.