期刊
JOURNAL OF HYPERTENSION
卷 35, 期 6, 页码 1302-1309出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HJH.0000000000001292
关键词
all-cause mortality; estimated glomerular filtration rate; folic acid therapy; hypertensive patients; proteinuria
资金
- Shenzhen AUSA Pharmed Co Ltd
- Projects of National Natural Science Foundation of China [81402735, 81473052]
- National Science and Technology Major Projects Specialized for 'Major New Drugs Innovation and Development' during the 12th Five-year Plan Period: China Stroke Primary Prevention Trial [zx09101105]
- Clinical Center Grant [zx09401013]
- National Key Research and Development Program [2016YFC0903100]
- Major Scientific and Technological Planning Project of Guangzhou [201505051532194, 15020010]
- Science, Technology and Innovation Committee of Shenzhen [JCYL20130401162636527]
- National Clinical Research Center for Kidney Disease, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
- State Key Laboratory for Organ Failure Research, Nanfang Hospital, Nanfang Medical University, Guangzhou, China
- Major State Basic Research Development Program of China (973 program) [2012CB517703]
- Department of Development and Reform, Shenzhen Municipal Government [SFG 20201744, JCYJ20130401162636527]
Objective:We aimed to evaluate whether proteinuria and estimated glomerular filtration rate (eGFR) levels can modify the efficacy of folic acid therapy on the risk of all-cause mortality among hypertensive patients in the China Stroke Primary Prevention Trial, a randomized, double-blind, and controlled trial. Methods:A total of 20702 hypertensive patients without a history of major cardiovascular diseases were randomly assigned to a double-blind daily treatment of a single tablet containing 10-mg enalapril and 0.8-mg folic acid (n = 10348), or 10-mg enalapril alone (n = 10354). All-cause mortality, a prespecified endpoint of the China Stroke Primary Prevention Trial, was the main outcome in this analysis. Results:Over a median treatment duration of 4.5 years, in the enalapril alone group, both heavy proteinuria [vs. absent, 10.8 vs. 2.7%; hazard ratio = 3.30; 95% confidence interval (CI): 2.10-5.18] and lower eGFR levels (<60 vs. 90ml/min per 1.73m(2), 13.0 vs. 2.2%; hazard ratio = 1.93; 95% CI: 1.19-3.12) were significantly associated with increased risk of all-cause mortality. Folic acid supplementation significantly reduced the risk of all-cause mortality in patients with heavy proteinuria (6.4% in the enalapril-folic acid vs. 10.8% in the enalapril alone group, hazard ratio = 0.49; 95% CI: 0.26-0.94), but not in those with absent or mild proteinuria (2.8 vs. 2.9%, hazard ratio = 0.99; 95% CI: 0.84-1.17; P for interaction = 0.040). However, eGFR levels did not significantly modify the effect of folic acid supplementation in reducing the risk of all-cause mortality (P for interaction = 0.228). Conclusion:Among hypertensive patients without a history of major cardiovascular diseases, folic acid therapy could reduce the mortality risk associated with heavy proteinuria.
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