Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN.
Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN.
Am J Kidney Dis. 2015 Aug;66(2):305-12. doi: 10.1053/j.ajkd.2015.01.018. Epub 2015 Mar 25.
Arterial stiffness is associated with elevated blood pressure (BP), but it is unclear whether it also makes hypertension more resistant to treatment. Among hypertensive dialysis patients, this study investigated whether aortic stiffness determines ambulatory BP and predicts its improvement with therapy.
Post hoc analysis of the Hypertension in Hemodialysis Patients Treated With Atenolol or Lisinopril (HDPAL) trial.
SETTINGS & PARTICIPANTS: 179 hypertensive hemodialysis patients with echocardiographic left ventricular hypertrophy.
Baseline aortic pulse wave velocity (PWV).
Baseline and treatment-induced change in 44-hour ambulatory BP at 3, 6, and 12 months.
Aortic PWV was assessed with an echocardiographic-Doppler technique (ACUSON Cypress, Siemens Medical), and 44-hour interdialytic ambulatory BP monitoring was performed with a Spacelabs 90207 monitor.
Mean baseline aortic PWV was 7.6±2.7 (SD) m/s. Overall treatment-induced changes in ambulatory systolic BP (SBP) were -15.6±20.4, -18.9±22.5, and -20.0±19.7 mmHg at 3, 6, and 12 months. Changes in SBP were no different among tertiles of baseline PWV. Aortic PWV was associated directly with baseline ambulatory SBP and pulse pressure (PP) and inversely with diastolic BP (DBP). After adjustment for several cardiovascular risk factors, each 1-m/s higher PWV was associated with 1.34-mm Hg higher baseline SBP (β=1.34±0.46; P=0.004) and 1.02-mm Hg higher PP (β=1.02±0.33; P=0.002), whereas the association with DBP was no longer significant. Baseline PWV did not predict treatment-induced changes in SBP (Wald test, P=0.3) and DBP (Wald test, P=0.7), but was a predictor of an overall improvement in PP during follow-up (Wald test, P=0.03).
Observational design; predominantly black patients were studied.
Because aortic PWV is not a predictor of treatment-induced change in ambulatory BP among hypertensive dialysis patients, it indicates that among these patients, hypertension can be controlled successfully regardless of aortic stiffness.
动脉僵硬度与血压升高有关，但尚不清楚它是否也使高血压更难以治疗。在高血压透析患者中，本研究旨在探讨主动脉僵硬度是否决定了动态血压，并预测其治疗后的改善。
阿托洛尔或赖诺普利治疗血液透析高血压患者（HDPAL）试验的事后分析。
179 名接受超声心动图左心室肥厚的高血压透析患者。
基线主动脉脉搏波速度（PWV）。
3、6 和 12 个月时 44 小时动态血压的基线和治疗诱导变化。
使用超声心动图-多普勒技术（ACUSON Cypress，Siemens Medical）评估主动脉 PWV，使用 Spacelabs 90207 监测仪进行 44 小时透析间动态血压监测。
平均基线主动脉 PWV 为 7.6±2.7（SD）m/s。总体治疗诱导的动态收缩压（SBP）变化在 3、6 和 12 个月时分别为-15.6±20.4、-18.9±22.5 和-20.0±19.7mmHg。基线 PWV 三分位组之间的 SBP 变化无差异。主动脉 PWV 与基线动态 SBP 和脉压（PP）直接相关，与舒张压（DBP）呈负相关。在调整了几个心血管危险因素后，每增加 1m/s 的 PWV 与基线 SBP 升高 1.34mmHg（β=1.34±0.46；P=0.004）和 PP 升高 1.02mmHg（β=1.02±0.33；P=0.002）相关，而与 DBP 的相关性不再显著。基线 PWV 不能预测 SBP（Wald 检验，P=0.3）和 DBP（Wald 检验，P=0.7）治疗诱导的变化，但它是随访期间 PP 总体改善的预测因子（Wald 检验，P=0.03）。
观察性设计；主要研究了黑人患者。
由于主动脉 PWV 不是高血压透析患者动态血压治疗诱导变化的预测因子，这表明在这些患者中，无论主动脉僵硬度如何，高血压都可以成功控制。
