降低高血压肾移植受者临床惰性的策略。
Strategies to reduce clinical inertia in hypertensive kidney transplant recipients.
作者信息
Kiberd James, Panek Romauld, Kiberd Bryce
机构信息
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
出版信息
BMC Nephrol. 2007 Jul 27;8:10. doi: 10.1186/1471-2369-8-10.
BACKGROUND
Many kidney transplant recipients have hypertension. Elevated systolic blood pressures are associated with lower patient and kidney allograft survival.
METHODS
This retrospective analysis examined the prevalence of clinical inertia (failure to initiate or increase therapy) in the treatment of hypertension before and after the introduction of an automated device (BpTRU) in the kidney transplant clinic.
RESULTS
Historically only 36% (49/134) of patients were prescribed a change in therapy despite a systolic blood pressure > or = 130 mmHg. After the introduction of BpTRU, 56% (62/110) of the patients had a change in therapy. In a multivariate logistic regression analysis of the entire cohort (n = 244) therapeutic changes were associated with higher blood pressures (OR 1.08 per mmHg, 95% CI 1.04-1.12) and use of the BpTRU (OR 2.12, 95% CI 1.72-3.83). In addition patients on more medications were also more likely to have a change in therapy.
CONCLUSION
Blood pressure measurement with automated devices may help reduce clinical inertia in the kidney transplant clinic.
背景
许多肾移植受者患有高血压。收缩压升高与患者及肾移植存活率降低相关。
方法
这项回顾性分析调查了肾移植门诊引入自动化设备（BpTRU）前后高血压治疗中临床惰性（未能启动或增加治疗）的发生率。
结果
从历史数据来看，尽管收缩压≥130 mmHg，但仅有36%（49/134）的患者接受了治疗方案的调整。引入BpTRU后，56%（62/110）的患者治疗方案发生了改变。在对整个队列（n = 244）进行的多因素逻辑回归分析中，治疗方案的改变与更高的血压（每毫米汞柱的比值比为1.08，95%可信区间为1.04 - 1.12）以及BpTRU的使用（比值比为2.12，95%可信区间为1.72 - 3.83）相关。此外，服用更多药物的患者也更有可能改变治疗方案。
结论
使用自动化设备测量血压可能有助于减少肾移植门诊的临床惰性。
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