四项独立横断面分析中肾移植受者高血压的治疗

Treatment of Hypertension in Renal Transplant Recipients in Four Independent Cross-Sectional Analyses.

作者信息

Kuźmiuk-Glembin Izabella, Adrych Dorota, Tylicki Leszek, Heleniak Zbigniew, Garnier Hanna, Wiśniewski Jakub, Rutkowski Przemysław, Rutkowski Bolesław, Dębska-Ślizień Alicja

机构信息

Unit of Clinical Pharmacology in the Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.

Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdansk, Gdansk, Poland.

出版信息

Kidney Blood Press Res. 2018;43(1):45-54. doi: 10.1159/000486905. Epub 2018 Jan 24.

DOI:10.1159/000486905

PMID:29402869

Abstract

BACKGROUND/AIMS: This retrospective study analysed hypertension management and adherence to blood pressure (BP) targets among renal transplant recipients (RTRs) under specialized care in the Outpatient Transplantation Unit in the Department of Nephrology, Transplantology and Internal Medicine at Gdansk University Hospital.

METHODS

Medical records of 101, 316, 639 and 818 RTRs diagnosed with hypertension, who received outpatient care in 2001, 2006, 2011 and 2014, respectively were analysed in four independent cross-sectional surveys. All RTRs received antihypertensive regimens.

RESULTS

The overall most commonly used antihypertensive agents were beta-blockers (BB) (range 66.3-82.5%) followed by calcium channel blockers (CCB) (range 52.8-64.2%). Whilst a significant, upward tendency of BB usage (p<0.01) was observed, CCB usage (p<0.001) displayed a downward tendency as a first line therapy in the subsequent years. The average number of antihypertensive agents used per patient increased significantly from 2.24±1.03 in 2001 to 2.55±1.25 in 2014 (p<0.05). The most frequently used combination of hypotensive therapy consisted of two or three antihypertensive drugs depending on the survey. The most common two drug combination consisted of BB and CCB followed by BB accompanied by angiotensin converting enzyme inhibitors. A significant, upward tendency in the use of four (p<0.001) and five (p<0.05) antihypertensive drugs simultaneously, was observed in subsequent years. The target values of BP i.e. <140/90 mmHg were accomplished in 47, 58, 60 and 46% of RTRs in subsequent years. In a secondary - stratified analysis of data from 2014, younger patients (p<0.05), patients with better graft function (p<0.001), patients treated with a higher number of antihypertensive agents (p<0.001) and those not treated with BB (p<0.01) were shown to reach the BP target of below 140/90 mmHg more often.

CONCLUSION

The study showed intensification of hypertension treatment in RTRs in subsequent years with BB assuming a dominant role.

摘要

背景/目的：本回顾性研究分析了格但斯克大学医院肾病、移植与内科门诊移植单元接受专科护理的肾移植受者（RTRs）的高血压管理情况及血压（BP）目标的达标情况。

方法

在四项独立的横断面调查中，分别分析了2001年、2006年、2011年和2014年接受门诊护理的101例、316例、639例和818例诊断为高血压的RTRs的病历。所有RTRs均接受抗高血压治疗方案。

结果

总体上最常用的抗高血压药物是β受体阻滞剂（BB）（范围为66.3%-82.5%），其次是钙通道阻滞剂（CCB）（范围为52.8%-64.2%）。虽然观察到BB使用量有显著的上升趋势（p<0.01），但CCB作为一线治疗的使用量在随后几年呈下降趋势（p<0.001）。每位患者使用的抗高血压药物平均数量从2001年的2.24±1.03显著增加到2014年的2.55±1.25（p<0.05）。根据调查，最常用的降压治疗组合由两种或三种抗高血压药物组成。最常见的两种药物组合是BB和CCB，其次是BB与血管紧张素转换酶抑制剂联用。在随后几年中，观察到同时使用四种（p<0.001）和五种（p<0.05）抗高血压药物的显著上升趋势。随后几年中，BP目标值即<140/90 mmHg在47%、58%、60%和46%的RTRs中得以实现。在对2014年数据的二次分层分析中，较年轻的患者（p<0.05）、移植肾功能较好的患者（p<0.001）、接受较多抗高血压药物治疗的患者（p<0.001）以及未接受BB治疗的患者（p<0.01）更常达到<140/90 mmHg的BP目标。