Health Promotion and Obesity Management Unit, Department of Pathophysiology Medical University of Silesia, Katowice, Poland.
Pathophysiology Unit, Department of Pathophysiology, Medical University of Silesia, Katowice, Poland.
Kidney Blood Press Res. 2017;42(6):1013-1022. doi: 10.1159/000485433. Epub 2017 Nov 30.
BACKGROUND/AIMS: Volume overload, frequently clinically asymptomatic is considered as a causative factor limiting the effectiveness of antihypertensive therapy in haemodialysis (HD) patients. Therefore, the aim of this study was to assess plasma levels of N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) and a C-terminal portion of the precursor of vasopressin (CT-proAVP, copeptin), surrogate markers of volume overload in HD patients in relation to the number of antihypertensive drugs used in the hypertension treatment.
One hundred and fifty adult HD patients (92 males) were enrolled into this study. Clinical data concerning blood pressure (BP) measurements prior haemodialysis session and pharmacotherapy were collected from all patients. In addition to routine laboratory parameters, plasma levels of NT-proBNP and CT-proAVP were measured, and daily sodium and water consumption were estimated with a portion-size food frequency questionnaire.
Among 145 (96.7%) hypertensive HD patients, 131 were receiving antihypertensive medication. Despite antihypertensive therapy, 31.0% had inadequate BP control. Plasma concentration of NT-proBNP was associated with systolic (R=0.19; p=0.02) but not diastolic BP values and with the number of received antihypertensive drugs (R=0.21; p=0.01). The highest NT-proBNP values were observed in patients receiving 3 or more antihypertensive drugs. In contrast, no significant correlation was found between plasma CT-proAVP concentrations and BP values as well as and the number of antihypertensive drugs. Receiver operator curve analysis showed that NT-proBNP values over 13,184 pg/mL predicted the use of at least 3 antihypertensive drugs in maximal doses in the therapy of hypertension, similar analyses performed for CT-proAVP showed much less specificity.
背景/目的：容量超负荷在临床上常无症状，但被认为是限制血液透析（HD）患者抗高血压治疗效果的一个因素。因此，本研究旨在评估 HD 患者血浆 N 端脑钠肽前体片段（NT-proBNP）和血管加压素前体 C 端部分（CT-proAVP， copeptin）水平，这些是容量超负荷的替代标志物，与高血压治疗中使用的降压药物数量有关。
本研究纳入了 150 名成年 HD 患者（92 名男性）。从所有患者中收集了血液透析前血压测量的临床数据和药物治疗情况。除了常规实验室参数外，还测量了 NT-proBNP 和 CT-proAVP 的血浆水平，并使用部分食物频率问卷估计了每日钠和水的摄入量。
在 145 名（96.7%）高血压 HD 患者中，有 131 名接受了降压药物治疗。尽管进行了降压治疗，但仍有 31.0%的患者血压控制不理想。NT-proBNP 血浆浓度与收缩压（R=0.19；p=0.02）而非舒张压值相关，与所接受的降压药物数量相关（R=0.21；p=0.01）。在接受 3 种或更多种降压药物的患者中观察到最高的 NT-proBNP 值。相比之下，血浆 CT-proAVP 浓度与 BP 值以及降压药物数量之间没有显著相关性。接受者操作特征曲线分析表明，NT-proBNP 值超过 13184 pg/mL 预测了高血压治疗中至少使用 3 种最大剂量的降压药物，对 CT-proAVP 进行类似的分析显示特异性较差。
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