Division of Nephrology, Department of Medicine, Indiana University School of Medicine, and Richard L. Roudebush Veterans' Affairs Medical Center, Indianapolis, Indiana 46202, USA.
Clin J Am Soc Nephrol. 2010 May;5(5):897-904. doi: 10.2215/CJN.08341109. Epub 2010 Feb 18.
Median BP obtained over a single dialysis treatment can diagnose hypertension among hemodialysis patients. Whether median BP is as useful to track change in BP is unknown.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among patients participating in the dry-weight reduction in hypertensive hemodialysis patients (DRIP) trial, interdialytic ambulatory BP was recorded at baseline, 4 weeks, and 8 weeks. The mean interdialytic ambulatory BP was compared to the following recordings: predialysis on one dialysis treatment (Pre1), predialysis averaged over 2 weeks of dialysis treatment (Pre6), postdialysis on one dialysis treatment (Post1), postdialysis averaged over 2 weeks of dialysis treatment (Post6), and median intradialytic BP over one treatment.
Pre1 was unable to detect change in ambulatory BP. Although Pre6 was able to detect change, it overestimated the ambulatory BP. On average, the magnitude of reduction in Post1 in response to probing dry-weight was nearly twice that obtained by ambulatory BP monitoring. Even Post6 overestimated the magnitude of reduction in BP at 8 weeks. Median systolic BP was responsive to probing dry-weight and neither overestimated nor underestimated the interdialytic ambulatory systolic BP at baseline or over time. However, the SD of the differences between median systolic BP and interdialytic ambulatory systolic BP varied from 16 to 20 mmHg.
Median intradialytic BP recordings can detect change in ambulatory BP evoked by reduction in dry-weight at the population level. Because of wide agreement limits between intradialytic and interdialytic BP, the individual prediction of ambulatory BP from median intradialytic BP can be misleading.
单次透析治疗中获得的血压中位数可用于诊断血液透析患者的高血压。但目前尚不清楚血压中位数是否有助于监测血压变化。
设计、地点、参与者和测量方法：在参与高血压血液透析患者干体重减少试验（DRIP）的患者中，在基线、4 周和 8 周时记录了透析间动态血压。将平均透析间动态血压与以下记录进行比较：一次透析治疗的透析前（Pre1）、两次透析治疗平均的透析前（Pre6）、一次透析治疗的透析后（Post1）、两次透析治疗平均的透析后（Post6）以及一次透析治疗中的血压中位数。
Pre1 无法检测到动态血压的变化。虽然 Pre6 能够检测到变化，但它高估了动态血压。平均而言，对干体重探测的反应，Post1 中的收缩压降低幅度几乎是动态血压监测的两倍。即使是 Post6 也高估了 8 周时的血压降低幅度。血压中位数对干体重探测敏感，在基线或随时间变化时，既不会高估也不会低估透析间动态收缩压。然而，血压中位数与透析间动态收缩压之间差异的标准差从 16 到 20mmHg 不等。
透析中血压中位数记录可以在人群水平上检测到干体重减少引起的动态血压变化。由于透析内和透析间血压之间的一致性限制较大，从透析内血压中位数对动态血压的个体预测可能会产生误导。
