Division of Kidney and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
Clin Exp Nephrol. 2012 Jun;16(3):427-32. doi: 10.1007/s10157-011-0575-1. Epub 2011 Dec 20.
Hypertension is a leading cause of cardiovascular (CV) disease in the general population. Although hypertension is very common in maintenance hemodialysis (HD) patients, adequate blood pressure (BP) values and measurement timing have not been defined.
A total of 49 hypertensive HD patients were recruited. Average age was 63 ± 11 years, and duration of dialysis therapy was 6.2 ± 4.2 years. Dialysis unit BPs and various types of home BPs were separately measured, and which BPs were the most critical markers in evaluating the effect of hypertension on left ventricular hypertrophy and CV events was investigated.
Predialysis systolic BPs were not correlated with any home BPs. Left ventricular mass index (LVMI) had a significant positive correlation with home BPs, especially morning systolic BPs on HD days (P < 0.01) and non-HD days (P < 0.05), on univariate and multivariate analysis. In contrast, predialysis BPs did not correlate with LVMI. During the follow-up period (47 ± 18 months), it was demonstrated that diabetes and home BPs, especially systolic BPs on the morning of HD days, were significant predictors of CV events on multivariate Cox regression analysis. A 10 mmHg increase in BP had a significantly elevated relative risk for CV events.
Home BP, especially systolic BPs in the morning on HD days, can provide pivotal information for management of HD patients.
高血压是普通人群心血管疾病的主要病因。尽管维持性血液透析（HD）患者中高血压很常见，但尚未确定适当的血压（BP）值和测量时间。
共招募了 49 例高血压 HD 患者。平均年龄为 63 ± 11 岁，透析治疗时间为 6.2 ± 4.2 年。分别测量了透析单元 BP 和各种类型的家庭 BP，并研究了哪种 BP 是评估高血压对左心室肥厚和心血管事件影响的最关键指标。
透析前收缩压与任何家庭 BP 均无相关性。左心室质量指数（LVMI）与家庭 BP 呈显著正相关，尤其是在 HD 日和非 HD 日的清晨收缩压（P < 0.01 和 P < 0.05），在单变量和多变量分析中均如此。相比之下，透析前 BP 与 LVMI 无关。在随访期间（47 ± 18 个月），多变量 Cox 回归分析表明，糖尿病和家庭 BP，尤其是 HD 日清晨的收缩压，是心血管事件的显著预测因素。BP 升高 10mmHg，心血管事件的相对风险显著增加。
家庭 BP，尤其是 HD 日清晨的收缩压，可以为 HD 患者的管理提供关键信息。
