纳入透析血压（BID）研究的高血压血液透析患者中，透析期间高血压与左心室质量的关联。
Association of Intradialytic Hypertension with Left Ventricular Mass in Hypertensive Hemodialysis Patients Enrolled in the Blood Pressure in Dialysis (BID) Study.
作者信息
Shamir Amith Roy, Karembelkar Ameet, Yabes Jonathan, Yao Yi, Miskulin Dana, Gassman Jennifer, Ploth David, Negrea Lavinia, Paine Susan, Rahman Mahboob, Kwong Raymond Y, Zager Philip, Jhamb Manisha
机构信息
Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Private Nephrology Practice, Pittsburgh, Pennsylvania, USA.
出版信息
Kidney Blood Press Res. 2018;43(3):882-892. doi: 10.1159/000490336. Epub 2018 May 30.
BACKGROUND/AIMS: Intradialytic hypertension (IDH), or paradoxical rise in blood pressure (BP) during hemodialysis (HD) is associated with increased morbidity and mortality. The association between IDH and increased left ventricular mass (LVM), a well-known risk factor for adverse cardiovascular outcomes in HD patients, has not been studied. The aim of our study is to evaluate the cross-sectional association of intradialytic change in BP with cardiac structure and function measured by cardiac MRI in hypertensive HD patients enrolled in the multi-center Blood Pressure in Dialysis (BID) clinical trial.
METHODS
Participants in the BID study were categorized into 3 groups based on average change (Δ) in systolic blood pressure (SBP) (post-HD SBP minus pre-HD SBP) during HD over a 1 month period: group 1 - patients with an increase in SBP ≥ 10mm Hg during HD (IDH); group 2 -patients with SBP decrease of greater ≥10mm Hg during HD; group 3 - patients with SBP increase or decrease by < 10mm Hg during HD. LVM index (LVMI) was measured using cardiac MRI, which were centrally read. Baseline characteristics were compared in the 3 groups and multivariable regression models were fitted for the adjusted association of IDH with LVMI.
RESULTS
Among the 80 participants, 7 (8.8%) had IDH and had average Δ SBP 17.0 ± 10.1 mmHg during HD. Patients with IDH were less likely to be diabetic, had lower pre-dialysis SBP and lower percent interdialytic weight gain as compared to the other 2 groups (p=0.02, p< 0.001 and p=0.02 respectively). In multivariable regression analyses, IDH was significantly associated with LVMI (adjusted mean difference relative to SBP decreased group [95% confidence interval (CI)] = 12.5 [3.6, 21.5], p=0.01) after adjusting for age, sex, diabetes, IDWG%, pre-HD SBP and beta blocker use. Every 1 mm rise in ΔSBP during HD was associated with 0.2 g/m2 increase in LVMI in adjusted models (p=0.04).
CONCLUSION
IDH is independently associated with higher LVMI in hypertensive HD patients and may contribute to increased cardiovascular events.
背景/目的：透析中高血压（IDH），即血液透析（HD）期间血压（BP）反常升高，与发病率和死亡率增加相关。IDH与左心室质量（LVM）增加之间的关联尚未得到研究，而左心室质量增加是HD患者不良心血管结局的一个众所周知的危险因素。我们研究的目的是在多中心透析血压（BID）临床试验的高血压HD患者中，评估透析中血压变化与通过心脏磁共振成像测量的心脏结构和功能之间的横断面关联。
方法
根据HD期间1个月内收缩压（SBP）的平均变化（Δ）（HD后SBP减去HD前SBP），将BID研究的参与者分为3组：第1组——HD期间SBP升高≥10mmHg的患者（IDH）；第2组——HD期间SBP下降≥10mmHg的患者；第3组——HD期间SBP升高或下降<10mmHg的患者。使用心脏磁共振成像测量LVM指数（LVMI），并进行集中解读。比较3组的基线特征，并拟合多变量回归模型以分析IDH与LVMI的校正关联。
结果
在80名参与者中，7名（8.8%）患有IDH，HD期间平均ΔSBP为17.0±10.1mmHg。与其他2组相比，IDH患者患糖尿病的可能性较小，透析前SBP较低，透析间期体重增加百分比也较低（分别为p=0.02、p<0.001和p=0.02）。在多变量回归分析中，调整年龄、性别、糖尿病、IDWG%、HD前SBP和β受体阻滞剂使用情况后，IDH与LVMI显著相关（相对于SBP下降组的校正平均差异[95%置信区间（CI）]=12.5[3.6，21.5]，p=0.01）。在调整模型中，HD期间ΔSBP每升高1mmHg与LVMI增加0.2g/m²相关（p=0.04）。
结论
在高血压HD患者中，IDH与较高的LVMI独立相关，可能导致心血管事件增加。
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