Antihypertensive treatment and risk of cardiovascular mortality in patients with chronic kidney disease diagnosed based on the presence of proteinuria and renal function: A large longitudinal study in Japan


Autoři: Kei Nagai aff001;  Kunihiro Yamagata aff001;  Kunitoshi Iseki aff002;  Toshiki Moriyama aff002;  Kazuhiko Tsuruya aff002;  Shouichi Fujimoto aff002;  Ichiei Narita aff002;  Tsuneo Konta aff002;  Masahide Kondo aff001;  Masato Kasahara aff002;  Yugo Shibagaki aff002;  Koichi Asahi aff002;  Tsuyoshi Watanabe aff002
Působiště autorů: University of Tsukuba, Tsukuba, Ibaraki, Japan aff001;  The Steering Committee for “Design of the Comprehensive Health Care System for Chronic Kidney Disease (CKD) Based on the Individual Risk Assessment by Specific Health Checkups”, Tsukuba, Ibaraki, Japan aff002;  Okinawa Heart and Renal Association, Okinawa, Japan aff003;  Health Care Center, Osaka University, Suita, Japan aff004;  Nara Medical University, Nara, Japan aff005;  University of Miyazaki, Miyazaki, Japan aff006;  Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan aff007;  Yamagata University Graduate School of Medical Science, Yamagata, Japan aff008;  Institute for Clinical and Translational Science, Nara Medical University Hospital, Nara, Japan aff009;  St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan aff010;  Iwate Medical University, Morioka, Japan aff011;  Fukushima Rosai Hospital, Iwaki, Japan aff012
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
prolekare.web.journal.doi_sk: 10.1371/journal.pone.0225812

Souhrn

Several recent clinical trials and meta-analyses have shown that lowering blood pressure reduces the risk of cardiovascular disease. However, current evidence that describes general demographics in blood pressure and mortality with chronic kidney disease is sparse in Japan. Using a population-based longitudinal cohort that received annual health checkups in Japan in 2008, hypertensive status, self-reported use of antihypertensive drugs, and prognosis were examined through 2012. Chronic kidney disease was defined as positive proteinuria or estimated glomerular filtration rate <60 ml/min/1.73 m2. Subjects were 40 to 74 years old (n = 227,204) with median 3.6 years follow-up period, and patients with and without chronic kidney disease were analyzed separately (n = 183,586 and n = 43,618, respectively). Cardiovascular disease mortality, comprising coronary heart diseases and stroke as entered in the national death registry using ICD-10 coding, was examined. Among all subjects, 346 deaths (96 in chronic kidney disease and 250 in non-chronic kidney disease) due to cardiovascular disease occurred. Compared with cardiovascular disease mortality in chronic kidney disease patients with untreated normal blood pressure, the multivariable adjusted hazard ratio was 3.08 (95% confidence interval: 1.75–5.41) for those with untreated hypertension, 2.30 (1.31–4.03) for those who became normotensive after treatment, and 3.28 (1.91–5.64) for those who remained hypertensive despite treatment. In non-chronic kidney disease subjects, the ratios were 1.90 (1.33–5.41), 1.95 (1.35–2.80), and 1.77 (1.18–2.66), respectively. These results from a nationwide cohort could be one of representative demographics of controlling blood pressure and cardiovascular disease deaths when treating patients with chronic kidney disease in Japan in recent years. Even after development and spread of anti-hypertensive drugs, preventing development of hypertension is preferable, because any hypertension treatment status comparing untreated normal blood pressure was a risk of cardiovascular mortality at baseline year.

Klíčová slova:

Antihypertensive drugs – Blood pressure – Cardiovascular diseases – Drug therapy – Hypertension – Chronic kidney disease – Proteinuria – Renal system


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