Norioka Naoki, Iwata Shinichi, Yanagi Shiro, Ishii Hideshi, Sugioka Kenichi, Kamimori Kimio, Ota Takahiro, Di Tullio Marco R, Homma Shunichi, Yoshiyama Minoru
Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi Abenoku, Osaka, 545-8585, Japan.
Department of Cardiology, Fuchu Hospital, Izumi, Japan.
Heart Vessels. 2016 Sep;31(9):1491-6. doi: 10.1007/s00380-015-0756-z. Epub 2015 Oct 5.
Aortic valve stenosis (AS) is a frequent complication contributing to poor prognosis in chronic hemodialysis (CHD) patients. High blood pressure (BP) is known to be associated with AS progression in the general population. In CHD patients, however, BP varies during and between hemodialysis sessions with ultrafiltration volume or inter-dialytic weight gain; therefore it is difficult to characterize the BP status with a conventional single measurement. Our purpose was to clarify the BP variables affecting AS progression in CHD patients. We retrospectively enrolled 32 consecutive CHD patients with AS [aortic valve area (AVA), 1.3 ± 0.3 cm(2); mean age 69 ± 8 years] who had serial transthoracic echocardiographic studies at least 6 months apart (mean 23 ± 9 months). AS progression was evaluated using absolute reduction in AVA per year. Pre-dialytic and intra-dialytic (every hour during sessions) BPs throughout the 3 consecutive visits were used to determine each patient's BP status. We calculated the mean values of pre-dialytic and intra-dialytic BPs and their variability. In univariate analysis, mean visit-to-visit pre-dialytic and intra-dialytic BP were associated with AS progression, whereas all variables of BP variability were not. Multiple regression analysis indicated that only mean visit-to-visit intra-dialytic systolic and diastolic BP remained independently associated with AS progression after adjustment for age, sex, hypertension, hypercholesterolemia, diabetes mellitus, and serum parathyroid hormone (p < 0.05). Although BP regulation in CHD patients is complex and multifactorial, mean visit-to-visit intra-dialytic BP was independently associated with AS progression. Prospective studies are necessary before considering intra-dialytic BP as a potential target for therapy.
主动脉瓣狭窄（AS）是慢性血液透析（CHD）患者预后不良的常见并发症。在普通人群中，高血压（BP）与AS进展相关。然而，在CHD患者中，血压会随着超滤量或透析间期体重增加在透析期间及透析间期发生变化；因此，很难通过传统的单次测量来描述血压状况。我们的目的是阐明影响CHD患者AS进展的血压变量。我们回顾性纳入了32例连续的患有AS的CHD患者[主动脉瓣面积（AVA），1.3±0.3cm²；平均年龄69±8岁]，这些患者至少相隔6个月（平均23±9个月）进行了系列经胸超声心动图检查。使用每年AVA的绝对减少量来评估AS进展。在连续3次就诊期间，使用透析前和透析期间（每次透析每小时）的血压来确定每位患者的血压状况。我们计算了透析前和透析期间血压的平均值及其变异性。在单因素分析中，透析前和透析期间每次就诊的平均血压与AS进展相关，而血压变异性的所有变量均无关。多因素回归分析表明，在对年龄、性别、高血压、高胆固醇血症、糖尿病和血清甲状旁腺激素进行校正后，仅每次就诊的透析期间收缩压和舒张压平均值仍与AS进展独立相关（p<0.05）。尽管CHD患者的血压调节复杂且多因素，但每次就诊的透析期间平均血压与AS进展独立相关。在将透析期间血压视为潜在治疗靶点之前，有必要进行前瞻性研究。
