Hompesch Catherine, Ma Tsung-Wei, Neyra Javier A, Ripley Lindsay, Xiao Guanghua, Inrig Jula, Toto Robert, Van Buren Peter N
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Kidney Blood Press Res. 2016;41(3):240-9. doi: 10.1159/000443427. Epub 2016 Apr 22.
BACKGROUND/AIMS: Intradialytic hypertension (IH) patients have higher mortality risk than other hemodialysis patients and have been shown to have higher ambulatory blood pressure (BP). We hypothesized that interdialytic BP patterns would differ in IH patients and hypertensive hemodialysis controls.
We consecutively screened hemodialysis patients at our university-affiliated units. Based on pre and post-HD BP measurements during the prior 2 week period, we identified IH patients and demographically matched hemodialysis controls. We measured ambulatory interdialytic BP, flow-mediated vasodilation, and intradialytic endothelin-1 (ET-1). Using linear mixed-models, we compared BP slopes during the following intervals: 1-24 hours post-dialysis, 25-44 hours post-dialysis, and 1-44 hours post-dialysis.
There were 25 case subjects with IH and 24 controls. Systolic BP during hours 1-44, 1-24, and 25-44 were 143.1 (16.5), 138.0 (21.2), and 150.8 (22.3) mmHg in controls. For IH subjects, they were 155.4 (14.2), 152.7 (22.8), and 156.5 (20.8) mmHg (p=0.008, 0.02, 0.4). In controls, the slopes were +0.6, +0.6, and +0.4 mmHg/hr. In IH subjects, they were +0.1, -0.3, and +0.3 mmHg/hr. The IH 1-24 hour slope differed from the IH 25-44 hour slope (p=0.001) and the control 1-24 hour slope (p=0.002). The change in ET-1 from pre to post dialysis was 0.5 (1.5) pg/mL in controls and 1.0 (2.3) pg/mL in IH patients (p=0.4). In a univariate model, there was an association with screening BP and BP slope (p=0.002 for controls and p=0.1 for IH patients).
Interdialytic BP patterns differ in IH patients and hemodialysis controls. The elevated post dialysis blood pressure persists for many hours in IH patients contributing to the overall increased BP burden.
背景/目的：透析期间高血压（IH）患者的死亡风险高于其他血液透析患者，且已显示其动态血压（BP）更高。我们假设IH患者和高血压血液透析对照者的透析间期血压模式会有所不同。
我们在大学附属医院连续筛查血液透析患者。根据前2周透析前和透析后的血压测量值，我们确定了IH患者以及在人口统计学上匹配的血液透析对照者。我们测量了动态透析间期血压、血流介导的血管舒张以及透析期间内皮素-1（ET-1）。使用线性混合模型，我们比较了以下时间段的血压斜率：透析后1 - 24小时、透析后25 - 44小时以及透析后1 - 44小时。
有25例IH患者和24例对照者。对照者在1 - 44小时、1 - 24小时和25 - 44小时的收缩压分别为143.1（16.5）mmHg、138.0（21.2）mmHg和150.8（22.3）mmHg。对于IH患者，分别为155.4（14.2）mmHg、152.7（22.8）mmHg和156.5（20.8）mmHg（p = 0.008、0.02、0.4）。对照者的斜率分别为 +0.6、+0.6和 +0.4 mmHg/小时。在IH患者中，分别为 +0.1、 -0.3和 +0.3 mmHg/小时。IH患者1 - 24小时的斜率与IH患者25 - 44小时的斜率不同（p = 0.001），与对照者1 - 24小时的斜率也不同（p = 0.002）。对照者透析前至透析后ET-1的变化为0.5（1.5）pg/mL，IH患者为1.0（2.3）pg/mL（p = 0.4）。在单变量模型中，筛查血压与血压斜率存在关联（对照者p = 0.002，IH患者p = 0.1）。
IH患者和血液透析对照者的透析间期血压模式不同。IH患者透析后血压升高会持续数小时，导致总体血压负担增加。
