血液透析人群中高血压的患病率。

Prevalence of hypertension in a hemodialysis population.

作者信息

Mittal S K, Kowalski E, Trenkle J, McDonough B, Halinski D, Devlin K, Boylan E, Flaster E, Maesaka J K

机构信息

Division of Nephrology and Academic Affairs, Winthrop University Hospital, Mineola, NY, USA.

出版信息

Clin Nephrol. 1999 Feb;51(2):77-82.

PMID:10069642

Abstract

BACKGROUND

Accurate information on prevalence and status of blood pressure (BP) control in hemodialysis patients is lacking. Our Hemodialysis Quality Improvement Program, sought to determine: 1) The extent and control of hypertension (HTN), 2) whether Erythropoietin (EPO) dose or intradialytic fluid loss had any effect on BP and 3) a means to follow the severity of HTN.

PATIENTS AND METHODS

The pre/post mid-week dialysis BP readings of 190 patients (64+/-14.1 years, 53% males, 77% whites) were evaluated over a 3 month period. HTN was defined as BP >150/90. Hypertension was further characterized according to whether the patients had normal or elevated pre-dialysis systolic, pre-dialysis diastolic, post-dialysis systolic or post-diastolic BP readings on more than 6 of the possible 13 recordings. The average EPO dose and weight loss during dialysis was correlated with BP. To better understand the extent of HTN, systolic and diastolic pressures were separately graded from 0 to 3 and a number designated as hypertension sensitivity index (HSI) was assigned to each patient.

RESULTS

Of the 190 patients, 146 (76.8%) were hypertensive. 117 out of 146 hypertensive patients (80.1%) had persistent elevation of BP despite being on one or more antihypertensive medications. Most patients were on calcium channel blockers (39%) with 27% being on beta-blockers and 14% on Angiotensin converting enzyme inhibitors. There was no correlation between the number of medications used and the control of HTN. The dose of EPO also had no effect on the degree of HTN. 69.8% of all HTN was systolic. Of this, 64.7% was pre-dialysis and 35.3% post-dialysis. Multiple regression analysis demonstrated a significant correlation with loss of weight during dialysis and lowering of systolic BP (r = 0.33, p = 0.0001). The mean HSI for this population was 2.3+/-1.8.

CONCLUSION

HTN was a frequent finding in our hemodialysis population and it was controlled in only 19.9% of hypertensive patients. Most of this HTN was pre-dialysis systolic. There was a significant correlation between fluid loss during dialysis and lowering of blood pressure. The use of the HSI has proven to be helpful in differentiating type and severity of HTN.

摘要

背景

目前缺乏关于血液透析患者血压（BP）控制的患病率和现状的准确信息。我们的血液透析质量改进项目旨在确定：1）高血压（HTN）的程度和控制情况；2）促红细胞生成素（EPO）剂量或透析期间的液体丢失是否对血压有任何影响；3）一种跟踪HTN严重程度的方法。

患者与方法

在3个月的时间里，对190名患者（64±14.1岁，53%为男性，77%为白人）周中透析前后的血压读数进行了评估。HTN定义为血压>150/90。根据患者在可能的13次记录中的6次以上透析前收缩压、透析前舒张压、透析后收缩压或透析后舒张压读数是否正常或升高，对高血压进行进一步分类。透析期间的平均EPO剂量和体重减轻与血压相关。为了更好地了解HTN的程度，将收缩压和舒张压分别从0到3进行分级，并为每个患者指定一个称为高血压敏感性指数（HSI）的数字。

结果

190名患者中，146名（76.8%）患有高血压。146名高血压患者中有117名（80.1%）尽管服用了一种或多种抗高血压药物，但血压仍持续升高。大多数患者服用钙通道阻滞剂（39%），27%服用β受体阻滞剂，14%服用血管紧张素转换酶抑制剂。所用药物数量与HTN控制之间没有相关性。EPO剂量对HTN程度也没有影响。所有HTN中有69.8%为收缩期高血压。其中，64.7%为透析前高血压，35.3%为透析后高血压。多元回归分析表明，透析期间体重减轻与收缩压降低之间存在显著相关性（r = 0.33，p = 0.0001）。该人群的平均HSI为2.3±1.8。