| Research background and purpose The damage of renal function is often one of the most important complications in hypertensive patients,which will eventually affect their life span.Among them,in AASK study,576 people with hypertensive kidney damage were followed up for 7 years and found about 33.5 % of the population,with the average annual decline of EGFR less than 1 ml /min / 1.73 m2.It is not only blood pressure that affects the change of renal function.A large number of cross-sectional studies show that the renal function will decline with age after the age of 40,and it is believed that the average annual decline rate is about 1 ml / min.A longitudinal study showed that about 43 % of the healthy population had no change or increase in EGFR in 5 years,and the average annual decline rate of EGFR was more than 1 % or the average annual change rate was more than or equal to 0.Ep idoso's study found that about 14.5 % of the elderly did not show a decrease in EGFR after a 10-year follow-up of people over 65 years of age.Research suggests that the decline of renal functionis not absolute.At present,there are limited longitudinal studies on the aging changes of renal function in elderly hypertensive patients in China,and the influencing factors of renal function changes in the population are also rare.Based on this background,this study explores the changes of renal function with age under blood pressure monitoring in elderly hypertensive patients from two aspects of cross-sectional survey and longitudinal study through the analysis of follow-up data.2.The influencing factors of renal function change in the population;3.The relationship between renal function change and all-cause death and other end-point events.To provide suggestions for the formulation of targeted and feasible treatment interventions to ensure that patients' medical and nursing needs are reasonably addressed.Objects and methods1.Research Methods: The follow-up data of patients with essential hypertension aged 65 or older who participated in the 2010 survey were extracted and analyzed,including questionnaire survey,physical examination,kidney-related biochemical indicators and related risk factors.Follow-up data collection is mainly based on the support and cooperation of the cadre's retreat where the investigation site is located,with the help of which follow-up subjects are tracked.Through centralized physical examination,subjects are invited to the designated investigation site and interviewed by trained and qualified medicalpersonnel,and information about blood pressure,diabetes and other diseases as well as treatment and hospitalization during the follow-up period is obtained.If the study object fails to come,relevant health care or case data will be transferred to obtain relevant follow-up information.2.age grouping: according to the 2010 data,the subjects were divided into two groups,with < 80 years old group and ? 80 years old group.3.renal function grouping: according to 2010 data,the subjects were divided into two groups,and EGFR < 60 ml /(min 1.73 m2)was recorded as abnormal.And calculate the change rate of all indicators in6 years,such as ? EGFR = [(value after 6 years-value before 6 years)/ value before 6 years ] × 100 %,and define the average annual change rate of EGFR,where ? EGFR / 6 ? 1 % is defined as increasing,-1 % < ? EGFR / 6< 1 % is defined as no change,and ? EGFR / 6 ?-1 % is defined as decreasing.4.Statistical methods: use SPSS 22.0 statistical software to input data and establish a database;The quantitative data were tested for normality,the mean standard deviation was used for statistical description when obeying normal distribution,and the independent sample t test was used for comparison between the two groups.The P50(P25,P75)was used for statistical description when not obeying normal distribution,and Mann-Whitney U test was used for comparison between the two groups.Qualitative data were statistically described by frequency,and ? 2 testwas used for inter-group comparison.The index of single factor analysis p < 0.05 was selected as the independent variable of multi-factor analysis,and multivariate logistic regression analysis or multivariate Cox regression analysis was performed.The difference was statistically significant with p < 0.05.Result1.Comparison of general clinical data and laboratory tests between the two groups in different age groups of the study population:In 2010,524 patients with complete data were divided into < 80-year-old group 158 and ? 80-year-old group 366 according to the baseline age.the systolic pressure between the two groups was controlled at 133 mmhg over 6 years.there were statistical differences between the baseline diastolic pressure,baseline EGFR,baseline cholesterol,baseline low density lipoprotein,diabetes history and coronary heart disease history and heart failure history(p < 0.05).2.Analysis of longitudinal changes of EGFR in the study population:(1)in this study,subjects were divided into 2 groups according to baseline age: the < 80-year-old group(n = 158)and the ? 80-year-old group(n = 366).One-way ANOVA was used to compare the EGFR size of the two groups of age groups.The results showed that EGFR decreased with age in hypertensive patients with stable blood pressure(P < 0.05)both at baseline and after 6 years.Under the sameblood pressure control,EGFR decreased significantly in the group less than 80 years old than in the group ? 80 years old(P < 0.05),and the overall EGFR decreased more steadily in the group ? 80 years old.(2)The baseline EGFR range of 524 subjects was 32-108 ml /(min1.73 m2),and the rate of EGFR change(? EGFR)during follow-up was-7 % 50 % / 6 years.According to the EGFR value,the baseline population was divided into two groups,the normal renal function group(? 60 ml /(min 1.73 m2),n = 424)and the abnormal renal function group(< 60 ml /(min 1.73 m2),n = 100).t-test analysis showed that the decline rate of EGFR was significantly higher in the normal renal function group than in the hyporenal function group(-12 % 34 % / 6years vs 14 % 88 % / 6 years),p < 0.01.(3)the results showed that the rate of delta EGFR decline in < 80 years old group(-17 % 31 % / 6 years)was significantly higher than that in? 80 years old group(3 % 56 % / 6 years),p < 0.01.(4)in this study,EGFR was defined as increasing or decreasing according to the annual rate of EGFR change ? 1 % during the follow-up,in which ? EGFR / 7 ? 1 % was defined as increasing,-1 % <? EGFR / 7 < 1 % was defined as no change,and ? EGFR / 6 ?-1 % was defined as decreasing.In this study,163 elderly hypertensive patients showed increased renal function after 5 years,6 showed unchanged renal function and 355 showed decreased renal function.Aftera 6-year follow-up,EGFR decreased in some groups,but not in 32 %of the population,suggesting that not all patients experienced an aging decline in EGFR.3.Analysis of influencing factors of renal function progress in different age groups:(1)After single factor risk analysis of possible risk factors,there were statistical differences in smoking history,baseline cholesterol,baseline low density lipoprotein and baseline EGFR in the ? 80-year-old group(P < 0.05).There were statistical differences in BMI,diabetes history and baseline EGFR in the < 80-year-old group(p < 0.05).(2)Six factors(BMI,diabetes history,smoking history,baseline cholesterol,baseline low density lipoprotein,baseline EGFR)screened by single factor analysis were used as independent variables,and the progress of renal function(progress assignment was 1,and non-progress assignment was 0)was used as dependent variables.the results showed that BMI,diabetes,smoking history,baseline cholesterol,baseline low density lipoprotein,baseline EGFR were independent factors affecting the progress of renal function when other confounding factors(BMI,diabetes history,smoking history,baseline EGFR)were corrected(p <0.05).Combined with the available regression coefficient,smoking was not controlled as an independent risk factor affecting renal function progression in the < 80-year-old group(i.e.,it could increase the riskof renal function progression);High baseline EGFR is an independent protective factor for renal function progression in the < 80-year-old group(i.e.,it can reduce the risk of renal function progression),or a decrease in baseline EGFR can increase the risk of renal function progression in the < 80-year-old group.For the ? 80-year-old group,high BMI and high baseline EGFR are independent protective factors for renal function progression(i.e.,can reduce the risk of renal function progression),or the decrease of BMI and baseline EGFR can increase the risk of renal function progression in the ? 80-year-old group.4.Analysis of influencing factors in non-renal failure group:(1)The results showed that BMI,baseline systolic blood pressure,baseline triglyceride,baseline EGFR and ARB were statistically different(P < 0.05).(2)Five factors selected by single factor analysis(BMI,baseline systolic pressure,baseline triglycerides,baseline EGFR,ARB drugs)were used as independent variables,and renal function progression(progression assignment is 1,and progression assignment is 0)was used as dependent variables.the results showed that BMI,baseline triglycerides,baseline EGFR,and baseline EGFR were independent influencing factors of renal function progression(p < 0.05)when other confounding factors(BMI,baseline systolic pressure,baseline triglycerides,ARB drugs)werecorrected,combined with the size of regression coefficient,triglycerides were not controlled for renal function.High BMI and high baseline EGFR are independent protective factors for renal function progression(i.e.,can reduce the risk of renal function progression),or lower BMI and baseline EGFR can increase the risk of renal function progression.5.Analysis of survival curve of age group and renal function progress group in the study population:(1)A total of 707 patients with complete data were investigated since2010,and 177(25.2 %)died as of December 31,2016.Cardiovascular death occurred in 21 cases(3.0 %)and cerebrovascular death in 5 cases(0.7 %).There were 197 cardiovascular events and 184 cerebrovascular events.(2)the elderly increased the risk of all-cause death in hypertensive patients,and there was a statistical difference(p < 0.05).(3)baseline GFR abnormality can increase the risk of all-cause death in hypertensive patients,with statistical difference(p < 0.05).(4)the decrease of EGFR change rate can increase the risk of all-cause death in hypertensive patients,with statistical difference(p < 0.05).(5)the decrease of EGFR change rate in elderly hypertensive patients can still increase the risk of all-cause death in hypertensive patients,with statistical difference(p < 0.05).(6)the decrease of EGFR change rate in elderly hypertensive patients can increase the risk of cardiovascular death in hypertensive patients with statistical difference(p < 0.05).Conclusion Cross-sectional analysis confirmed that EGFR decreased with age in the elderly hypertensive population,but longitudinal studies showed that about 32 % of the population had an average annual decrease rate of <1 % or no decrease in EGFR in 6 years.In addition to aging and baseline renal function can affect the rate of EGFR decline in the population,low BMI and smoking are also independent risk factors that affect the rate of EGFR decline.The risk factors of the population without renal function decline were high triglycerides,low BMI and low baseline renal function.Aging,low baseline EGFR,and rapid rate of EGFR decline increase the risk of all-cause death in hypertensive patients. |
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