Liu Jiung-Hsiun, Chen Ching-Chu, Wang Shu-Ming, Chou Che-Yi, Liu Yao-Lung, Kuo Huey-Liang, Lin Hsin-Hung, Wang I-Kuan, Yang Ya-Fei, Huang Chiu-Ching
Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Am J Hypertens. 2008 Dec;21(12):1318-23. doi: 10.1038/ajh.2008.286. Epub 2008 Sep 18.
Pulse pressure (PP) is an independent predictor of cardiovascular and/or all-cause mortality in patients with underlying cardiovascular disease. We examined whether PP can be used to predict overall mortality in peritoneal dialysis (PD) patients.
We studied 153 PD patients (mean age, 54.5 +/- 14.2 years) with end-stage renal disease. PP was measured monthly for 3 months. At the time of the third PP measurement, baseline demographic, clinical, biochemical, and dialysis data were collected. Patients were stratified into tertiles according to average PP, and the relationship between blood pressure parameters and all-cause mortality over a 30-month follow-up was assessed using Cox regression.
There were 27 deaths; three deaths occurred after the change to hemodialysis (HD) (subjects died within 3 months after HD) and were counted as events during survival analysis. The overall 30-month survival (Kaplan-Meier curves) times were significantly different among the tertiles of PP (P < 0.05). Increased PP was significantly associated with overall mortality regardless of adjustment for systolic blood pressure (SBP) or diastolic blood pressure (DBP).
PP may be the most consistent blood pressure indicator of mortality risk. All-cause mortality events in PD patients are more related to pulsatile stress caused by the stiffness of large arteries during systole (reflected in a rise of PP) than to steady-state stress stemming from resistance during diastole (reflected in a rise of SBP and DBP).
脉压（PP）是潜在心血管疾病患者心血管和/或全因死亡率的独立预测指标。我们研究了PP是否可用于预测腹膜透析（PD）患者的总体死亡率。
我们研究了153例患有终末期肾病的PD患者（平均年龄54.5±14.2岁）。连续3个月每月测量PP。在第三次测量PP时，收集基线人口统计学、临床、生化和透析数据。根据平均PP将患者分为三分位数，并使用Cox回归评估血压参数与30个月随访期间全因死亡率之间的关系。
共有27例死亡；3例死亡发生在转为血液透析（HD）后（患者在HD后3个月内死亡），在生存分析中被计为事件。PP三分位数之间的总体30个月生存率（Kaplan-Meier曲线）时间有显著差异（P<0.05）。无论收缩压（SBP）或舒张压（DBP）如何调整，PP升高均与总体死亡率显著相关。
PP可能是死亡率风险最一致的血压指标。PD患者的全因死亡事件与收缩期大动脉僵硬引起的搏动性应激（反映为PP升高）的关系比与舒张期阻力引起的稳态应激（反映为SBP和DBP升高）的关系更大。
