Kidney Disease, Intensive Hypertension Treatment, and Risk for Dementia and Mild Cognitive Impairment: The Systolic Blood Pressure Intervention Trial.

Autor:	Kurella Tamura M; Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, California mktamura@stanford.edu.; Division of Nephrology, Stanford University School of Medicine, Palo Alto, California., Gaussoin SA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina., Pajewski NM; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, North Carolina., Chelune GJ; Center for Alzheimer's Care, Imaging and Research, University of Utah School of Medicine, Salt Lake City, Utah., Freedman BI; Section of Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina., Gure TR; Division of General Internal Medicine and Geriatrics, The Ohio State University, Columbus, Ohio., Haley WE; Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida., Killeen AA; Departments of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota., Oparil S; Vascular Biology and Hypertension Program, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama., Rapp SR; Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina., Rifkin DE; Division of Nephrology, University of California San Diego, San Diego, California., Supiano M; Division of Geriatrics, University of Utah School of Medicine, Salt Lake City, Utah., Williamson JD; Sticht Center for Healthy Aging and Alzheimer's Prevention and Division of Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina., Weiner DE; Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2020 Sep; Vol. 31 (9), pp. 2122-2132. Date of Electronic Publication: 2020 Jun 26.
DOI:	10.1681/ASN.2020010038
Abstrakt:	Background: Intensively treating hypertension may benefit cardiovascular disease and cognitive function, but at the short-term expense of reduced kidney function. Methods: We investigated markers of kidney function and the effect of intensive hypertension treatment on incidence of dementia and mild cognitive impairment (MCI) in 9361 participants in the randomized Systolic Blood Pressure Intervention Trial, which compared intensive versus standard systolic BP lowering (targeting <120 mm Hg versus <140 mm Hg, respectively). We categorized participants according to baseline and longitudinal changes in eGFR and urinary albumin-to-creatinine ratio. Primary outcomes were occurrence of adjudicated probable dementia and MCI. Results: Among 8563 participants who completed at least one cognitive assessment during follow-up (median 5.1 years), probable dementia occurred in 325 (3.8%) and MCI in 640 (7.6%) participants. In multivariable adjusted analyses, there was no significant association between baseline eGFR <60 ml/min per 1.73 m 2 and risk for dementia or MCI. In time-varying analyses, eGFR decline ≥30% was associated with a higher risk for probable dementia. Incident eGFR <60 ml/min per 1.73 m 2 was associated with a higher risk for MCI and a composite of dementia or MCI. Although these kidney events occurred more frequently in the intensive treatment group, there was no evidence that they modified or attenuated the effect of intensive treatment on dementia and MCI incidence. Baseline and incident urinary ACR ≥30 mg/g were not associated with probable dementia or MCI, nor did the urinary ACR modify the effect of intensive treatment on cognitive outcomes. Conclusions: Among hypertensive adults, declining kidney function measured by eGFR is associated with increased risk for probable dementia and MCI, independent of the intensity of hypertension treatment. (Copyright © 2020 by the American Society of Nephrology.)
Databáze:	MEDLINE
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