Indiana University, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN 46202, USA.
Hypertension. 2010 Mar;55(3):762-8. doi: 10.1161/HYPERTENSIONAHA.109.144899. Epub 2010 Jan 18.
Blood pressure measured before and after dialysis does not agree well with those recorded outside the dialysis unit. Whether recordings obtained outside the dialysis unit are of greater prognostic value than blood pressure obtained just before and after dialysis remains incompletely understood. Among 326 patients on long-term hemodialysis, blood pressure was self-measured at home for 1 week, over an interdialytic interval by ambulatory recording and before and after dialysis over 2 weeks. Over a mean follow-up of 32 (SD 20) months, 102 patients died (31%), yielding a crude mortality rate of 118/1000 patient years. Systolic but not diastolic blood pressure was found to be of prognostic importance. Adjusted and unadjusted multivariate analyses showed increasing quartiles of ambulatory and home systolic blood pressure to be associated with all-cause mortality (adjusted hazard ratios for increasing quartiles of ambulatory: 2.51, 3.43, 2.62; and for home blood pressure: 2.15, 1.7, 1.44). Mortality was lowest when home systolic blood pressure was between 120 to 130 mm Hg and ambulatory systolic blood pressure was between 110 to 120 mm Hg. Blood pressure recorded before and after dialysis was not statistically significant (P=0.17 for predialysis, and P=0.997 for postdialysis) in predicting mortality. Out-of-dialysis unit blood pressure measurement provided superior prognostic information compared to blood pressure within the dialysis unit (likelihood ratio test, P<0.05). Out-of-dialysis unit blood pressure among hemodialysis patients is prognostically more informative than that recorded just before and after dialysis. Therefore, the management of hypertension among these patients should focus on blood pressure recordings outside the dialysis unit.
透析前后测量的血压与透析单元外记录的血压并不完全一致。在透析单元外获得的记录是否比透析前后获得的血压具有更大的预后价值仍不完全清楚。在 326 名长期血液透析患者中，患者在家中进行了为期 1 周的自我血压测量，通过动态记录测量了 1 次透析间隔期间的血压，并在 2 周内测量了透析前后的血压。在平均 32（SD 20）个月的随访中，有 102 名患者死亡（31%），粗死亡率为 118/1000 患者年。结果发现收缩压而不是舒张压具有预后意义。调整和未调整的多变量分析显示，动态和家庭收缩压的四分位间距增加与全因死亡率相关（调整后的四分位间距增加的风险比为：动态 2.51、3.43、2.62；家庭血压 2.15、1.7、1.44）。当家庭收缩压在 120 至 130 mmHg 之间且动态收缩压在 110 至 120 mmHg 之间时，死亡率最低。透析前和透析后血压记录在预测死亡率方面没有统计学意义（透析前 P=0.17，透析后 P=0.997）。与透析单元内的血压相比，透析单元外的血压测量提供了更好的预后信息（似然比检验，P<0.05）。血液透析患者透析单元外的血压比透析前后记录的血压更具有预后信息。因此，这些患者的高血压管理应侧重于透析单元外的血压记录。
