van Zuilen A D, Blankestijn P J, van Buren M, Ten Dam M A G J, Kaasjager K A H, Ligtenberg G, Sijpkens Y W J, Sluiter H E, van de Ven P J G, Vervoort G, Vleming L, Bots M L, Wetzels J F M
Department of Nephrology, University Medical Center Utrecht, Utrecht, the Netherlands.
Neth J Med. 2011 May;69(5):229-36.
Blood pressure (BP) is the most important modifiable risk factor for cardiovascular (CV) disease and progression of kidney dysfunction in patients with chronic kidney disease. Despite extensive antihypertensive treatment possibilities, adequate control is notoriously hard to achieve. Several determinants have been identified which affect BP control. In the current analysis we evaluated differences in achieved BP and achievement of the BP goal between hospitals and explored possible explanations.
At baseline, BP was measured in a supine position with an oscillometric device in 788 patients participating in the MASTER PLAN study. We also retrieved the last measured office BP from the patient records. Additional baseline characteristics were derived from the study database. Univariate and multivariate analyses were performed with general linear modelling using hospital as a random factor.
In univariate analysis, hospital was a determinant of the level of systolic and diastolic BP at baseline. Adjustment for patient, kidney disease, treatment or hospital characteristics affected the relation. Yet, in a fully adjusted model, differences between centres persisted with a range of 15 mmHg for systolic BP and 11 mmHg for diastolic BP.
Despite extensive adjustments, a clinically relevant, statistically significant difference between hospitals was found in standardised BP measurements at baseline of a randomised controlled study. We hypothesise that differences in the approach towards BP control exist at the physician level and that these explain the differences between hospitals.
血压（BP）是心血管疾病（CV）以及慢性肾病患者肾功能不全进展的最重要的可改变风险因素。尽管有广泛的抗高血压治疗方法，但众所周知，要实现充分控制却很困难。已经确定了几个影响血压控制的决定因素。在当前的分析中，我们评估了不同医院之间血压控制情况以及血压目标达成情况的差异，并探讨了可能的原因。
在基线时，使用示波装置对参与MASTER PLAN研究的788名患者进行仰卧位血压测量。我们还从患者记录中获取了最后一次测量的诊室血压。其他基线特征来自研究数据库。使用医院作为随机因素，通过一般线性模型进行单变量和多变量分析。
在单变量分析中，医院是基线时收缩压和舒张压水平的一个决定因素。对患者、肾病、治疗或医院特征进行调整会影响这种关系。然而，在一个完全调整的模型中，各中心之间的差异仍然存在，收缩压相差15 mmHg，舒张压相差11 mmHg。
尽管进行了广泛的调整，但在一项随机对照研究的基线标准化血压测量中，发现不同医院之间存在具有临床相关性且具有统计学意义的差异。我们推测在医生层面存在血压控制方法的差异，这解释了不同医院之间的差异。
