高血压血液透析患者血压控制不佳的相关因素。

Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients.

作者信息

Rahman M, Dixit A, Donley V, Gupta S, Hanslik T, Lacson E, Ogundipe A, Weigel K, Smith M C

机构信息

Department of Medicine, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, OH 44106, USA.

出版信息

Am J Kidney Dis. 1999 Mar;33(3):498-506. doi: 10.1016/s0272-6386(99)70187-3.

DOI:10.1016/s0272-6386(99)70187-3

PMID:10070914

Abstract

Hypertension is common in hemodialysis patients and increases cardiovascular morbidity and mortality. We determined the prevalence of inadequate control of hypertension in 489 patients receiving hemodialysis and identified factors associated with uncontrolled hypertension. We interviewed the patients and abstracted demographic and clinical information from a computerized database. The prevalence of uncontrolled hypertension (average predialysis blood pressure, > or =160/90 mm Hg) was 62%. Ninety-one percent of patients with uncontrolled hypertension were receiving submaximal antihypertensive drug therapy, and 59% withheld their medications before dialysis. Uncontrolled hypertensives had a greater interdialytic weight gain (3.8% v 3.5%, P = 0.07) and a greater excess weight gain (3.1 +/- 1.6 kg v 2.5 +/- 1.4 kg; P < 0.05) compared with controlled hypertensives. Patients with uncontrolled hypertension showed higher interdialytic weight gain (2.7 +/- 0.06 kg v 2.2 +/- 0.13 kg; P < 0.05), were more likely to be black (94% v 81%; P < 0.05), were more likely to have hypertension as the cause of their end-stage renal disease (ESRD) (42% v 24%; P < 0.05), and had been receiving hemodialysis for a shorter time (4.3 +/- 2 yr v 6.1 +/- 0.9 yr; P < 0.05) compared with normotensive patients. There was significant correlation between diastolic blood pressure and both interdialytic weight gain (r = 0.31, P < 0.05) and percent weight gain (r = 0.34, P < 0.05) in the hypertensive but not in the normotensive patients (r = -0.21). Interdialytic weight gain and hypertension as a cause of ESRD were independent predictors of predialysis systolic blood pressure. We conclude that hypertension is uncontrolled in most patients undergoing hemodialysis. Submaximal antihypertensive therapy, excessive interdialytic weight gain, and withholding antihypertensive medication before dialysis are correctable factors potentially contributing to uncontrolled hypertension.

摘要

高血压在血液透析患者中很常见，会增加心血管疾病的发病率和死亡率。我们确定了489例接受血液透析患者中高血压控制不佳的患病率，并确定了与高血压控制不佳相关的因素。我们对患者进行了访谈，并从计算机数据库中提取了人口统计学和临床信息。高血压控制不佳（透析前平均血压≥160/90 mmHg）的患病率为62%。91%高血压控制不佳的患者接受的是次最大剂量的抗高血压药物治疗，59%的患者在透析前停用了药物。与血压得到控制的患者相比，高血压控制不佳的患者透析间期体重增加更多（3.8%对3.5%，P = 0.07），超重增加更多（3.1±1.6 kg对2.5±1.4 kg；P < 0.05）。高血压控制不佳的患者透析间期体重增加更高（2.7±0.06 kg对2.2±0.13 kg；P < 0.05），更有可能是黑人（94%对81%；P < 0.05），更有可能因高血压导致终末期肾病（ESRD）（42%对24%；P < 0.05），并且与血压正常的患者相比，接受血液透析的时间更短（4.3±2年对6.1±0.9年；P < 0.05）。在高血压患者中，舒张压与透析间期体重增加（r = 0.31，P < 0.05）和体重增加百分比（r = 0.34，P < 0.05）之间存在显著相关性，而在血压正常的患者中则无相关性（r = -0.21）。透析间期体重增加和高血压作为ESRD的病因是透析前收缩压的独立预测因素。我们得出结论，大多数接受血液透析的患者高血压未得到控制。次最大剂量的抗高血压治疗、透析间期体重过度增加以及透析前停用抗高血压药物是可能导致高血压控制不佳的可纠正因素。