Academic Department of Renal Medicine, King's College Hospital, London, UK.
Nephron Clin Pract. 2012;120(3):c147-55. doi: 10.1159/000337571. Epub 2012 Jun 5.
BACKGROUND/AIMS: Data on the prevalence, treatment and control of hypertension in patients with advanced chronic kidney disease (CKD) are limited. This study aimed to examine the above factors in a cohort of predialysis patients.
During a period of 4 months, we recorded information on blood pressure (BP), comorbidities, medications and related parameters of patients followed up in the Low-Clearance Clinic of our Department. Control rates of hypertension were calculated at two thresholds: <130/80 and <140/90 mm Hg. Univariate and multiple linear regression analyses were employed to assess factors associated with BP control.
In the population studied [n = 238, males 58.4%, age 66.21 ± 4.2 years (mean ± SD), estimated glomerular filtration rate 14.5 ± 4.8 ml/min/1.73 m(2)], the prevalence of hypertension was 95.0%. Treatment rate among hypertensives was at 99.1%. On average, 3.04 ± 1.32 antihypertensive drugs were used, ranging from 1 to 7 agents. BP control rates at the <130/80 and <140/90 mm Hg thresholds were 26.5% and 48.2%, respectively. The systolic goal was achieved in 31.0% and 50.4%, whereas the diastolic goal was achieved in 67.7% and 91.2% of patients, respectively. In multivariate analysis, only black race was independently and inversely related with hypertension control (β = -0.187, p = 0.030). No specific antihypertensive class showed independent associations with control.
Hypertension is highly prevalent in predialysis CKD patients. An almost universal treatment, employing a multi-agent regime, can help towards improved rates of control. Systolic BP is the main barrier to successful control and black race is associated with poorer control rates.
背景/目的：有关晚期慢性肾脏病（CKD）患者高血压的患病率、治疗和控制的数据有限。本研究旨在检查透析前患者队列中的上述因素。
在 4 个月的时间内，我们记录了在我们部门的低清除率诊所接受随访的患者的血压（BP）、合并症、药物和相关参数信息。高血压的控制率在两个阈值下计算：<130/80 和 <140/90mmHg。采用单变量和多元线性回归分析评估与 BP 控制相关的因素。
在所研究的人群中[n=238，男性占 58.4%，年龄 66.21±4.2 岁（平均值±标准差），估算肾小球滤过率 14.5±4.8ml/min/1.73m2]，高血压的患病率为 95.0%。高血压患者的治疗率为 99.1%。平均使用 3.04±1.32 种降压药，范围为 1 至 7 种药物。<130/80 和 <140/90mmHg 阈值下的血压控制率分别为 26.5%和 48.2%。收缩压目标分别在 31.0%和 50.4%的患者中达到，而舒张压目标分别在 67.7%和 91.2%的患者中达到。多元分析显示，只有黑种人种族与高血压控制呈独立且负相关（β=-0.187，p=0.030）。没有特定的降压药类别与控制有独立关联。
透析前 CKD 患者高血压患病率很高。几乎普遍的治疗方法，采用多药治疗方案，可以帮助提高控制率。收缩压是成功控制的主要障碍，黑种人种族与较差的控制率相关。
