Przybylowski P, Malyszko J, Malyszko J S, Kobus G, Sadowski J, Mysliwiec M
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Kracow, Poland.
Transplant Proc. 2010 Dec;42(10):4263-6. doi: 10.1016/j.transproceed.2010.09.025.
Hypertension is widely accepted as a risk factor for coronary artery disease, heart failure, stroke, or chronic kidney disease. According to ESH/ESC and JNC guidelines, the target blood pressure should be low 140/90 mm Hg in the general population, and 130/80 mm Hg among patients with chronic kidney disease or diabetes. The aim of this study was to assess the prevalence of achieved target blood pressure among 164 prevalent heart transplant recipients as well as 172 prevalent, kidney transplant, 100 hemodialyzed, and 50 peritoneally dialyzed patients on renal replacement therapy. We assessed kidney function in transplanted patients using the simplified MDRD formula. In the heart transplant (OHT) population, 10% had diabetes and 65% chronic kidney disease; in the kidney transplant population 18% had diabetes. Hypertension was treated in 70% of OHT, 92% of kidney 90% of hemodialyzed and 70% of peritoneally dialyzed patients. In the OHT population, only 43% of subjects achieved the target blood pressure, while 42% among kidney transplant, 50% of hemodialzyed, and only 20% of peritoneally dialyzed patients did so. Hypertensive OHT as well as kidney transplant subjects were older, displayed higher serum creatinine values and lower estimated glomerular filtration rates. Hypertensive patients after OHT were treated with ACE inhibitors (50%), calcium channel blockers (55%), diuretics (34%), β-blockers (34%), and/or spironolactone (5%). Among hypertensive kidney allograft recipients, the most commonly used drugs were calcium channel blockers (80%), β-blockers (60%), diuretics (55%) ACE inhibitors (40%), and α-blockers (12%). The kidney transplant population required three and more hypotensives in 63% of cases. Despite polytherapy optimal blood pressure control was not achieved in the majority of patients. OHT and kidney graft recipients displayed a high prevalence of hypertension, which should be treated adequately. More efforts must be dedicated to optimize blood pressure control, particularly in the presence of other comorbidities.
高血压被广泛认为是冠状动脉疾病、心力衰竭、中风或慢性肾病的危险因素。根据欧洲高血压学会/欧洲心脏病学会（ESH/ESC）和美国国立综合癌症网络（JNC）指南，一般人群的目标血压应低于140/90 mmHg，慢性肾病或糖尿病患者的目标血压应低于130/80 mmHg。本研究旨在评估164例心脏移植受者以及172例肾移植受者、100例接受血液透析的患者和50例接受腹膜透析的肾替代治疗患者中达到目标血压的患病率。我们使用简化的肾脏病饮食改良（MDRD）公式评估移植患者的肾功能。在心脏移植（OHT）人群中，10%患有糖尿病，65%患有慢性肾病；在肾移植人群中，18%患有糖尿病。70%的OHT患者、92%的肾移植患者、90%的血液透析患者和70%的腹膜透析患者接受了高血压治疗。在OHT人群中，只有43%的受试者达到了目标血压，而肾移植患者中这一比例为42%，血液透析患者中为50%，腹膜透析患者中仅为20%。高血压的OHT患者以及肾移植患者年龄更大，血清肌酐值更高，估计肾小球滤过率更低。OHT术后的高血压患者接受了血管紧张素转换酶（ACE）抑制剂（50%）、钙通道阻滞剂（55%）、利尿剂（34%）、β受体阻滞剂（34%）和/或螺内酯（5%）治疗。在高血压肾移植受者中，最常用的药物是钙通道阻滞剂（80%）、β受体阻滞剂（60%）、利尿剂（55%）、ACE抑制剂（40%）和α受体阻滞剂（12%）。63%的肾移植患者需要三种及以上降压药。尽管采用了联合治疗，但大多数患者仍未实现最佳血压控制。OHT患者和肾移植受者高血压患病率较高，应进行充分治疗。必须做出更多努力来优化血压控制，尤其是在存在其他合并症的情况下。
