Moriya Hidekazu, Oka Machiko, Maesato Kyoko, Mano Tsutomu, Ikee Ryota, Ohtake Takayasu, Kobayashi Shuzo
Shonan Kamakura General Hospital, Department of Nephrology, and Kidney & Dialysis Center, 1202-1 Yamazaki Kamakura, Kanagawa 247-8533, Japan.
Clin J Am Soc Nephrol. 2008 Mar;3(2):416-22. doi: 10.2215/CJN.03490807. Epub 2008 Jan 16.
With regard to monitoring blood pressure in hemodialysis patients, it is important to define clearly the time point at which the blood pressure is measured, because the blood pressure of hemodialysis patients varies with each hemodialysis session as a result of loss of excess fluid.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Using weekly averaged blood pressure, 96 hemodialysis patients were studied prospectively for 35 mo. All patients were followed up for cardiovascular events or death from all causes.
Pulse weekly averaged blood pressure and age at enrollment were significantly higher and parathyroid hormone level was significantly lower in patients with cardiovascular events compared with those without cardiovascular events; however, none of the components of pre- or postdialysis blood pressure was significantly different between patients with and without cardiovascular events. Pulse weekly averaged blood pressure, prepulse pressure, age, and human atrial natriuretic peptide were significantly higher in patients who died than in survivors. Kaplan-Meier method with a log-rank test demonstrated that survival free rate from cardiovascular events and that of all-cause mortality in patients with pulse weekly averaged blood pressure > or =70 mmHg were significantly lower than those in the remaining patients.
One-point measurement of blood pressure is insufficient to evaluate hypertension and prognosis of hemodialysis patients, and weekly averaged blood pressure is a useful marker because of averaging fluctuations of blood pressure during 1 wk. Among components of weekly averaged blood pressure, pulse weekly averaged blood pressure could be a good prognostic marker of the incidence of both cardiovascular events and all-cause mortality in hemodialysis patients.
对于监测血液透析患者的血压，明确测量血压的时间点非常重要，因为血液透析患者的血压会因每次透析过程中过多液体的流失而在每次透析期间有所变化。
设计、地点、参与者及测量方法：使用每周平均血压，对96例血液透析患者进行了为期35个月的前瞻性研究。所有患者均随访心血管事件或各种原因导致的死亡情况。
与无心血管事件的患者相比，发生心血管事件的患者其每周平均脉搏血压和入组时年龄显著更高，甲状旁腺激素水平显著更低；然而，透析前或透析后血压的各项组成部分在有心血管事件和无心血管事件的患者之间均无显著差异。死亡患者的每周平均脉搏血压、脉前压力、年龄和心房利钠肽水平均显著高于存活患者。采用对数秩检验的Kaplan-Meier法表明，每周平均脉搏血压≥70 mmHg的患者发生心血管事件的生存率和全因死亡率显著低于其余患者。
单次血压测量不足以评估血液透析患者的高血压情况和预后，每周平均血压是一个有用的指标，因为它能平均一周内血压的波动情况。在每周平均血压的各项组成部分中，每周平均脉搏血压可能是血液透析患者心血管事件发生率和全因死亡率的良好预后指标。
