Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
CNR-IFC Clinical Epidemiology of Renal Diseases and Hypertension, Reggio Calabria, Italy.
Nephrol Dial Transplant. 2019 Sep 1;34(9):1542-1548. doi: 10.1093/ndt/gfy147.
Population-specific consensus documents recommend that the diagnosis of hypertension in haemodialysis patients be based on 48-h ambulatory blood pressure (ABP) monitoring. However, until now there is just one study in the USA on the prevalence of hypertension in haemodialysis patients by 44-h recordings. Since there is a knowledge gap on the problem in European countries, we reassessed the problem in the European Cardiovascular and Renal Medicine working group Registry of the European Renal Association-European Dialysis and Transplant Association.
A total of 396 haemodialysis patients underwent 48-h ABP monitoring during a regular haemodialysis session and the subsequent interdialytic interval. Hypertension was defined as (i) pre-haemodialysis blood pressure (BP) ≥140/90 mmHg or use of antihypertensive agents and (ii) ABP ≥130/80 mmHg or use of antihypertensive agents.
The prevalence of hypertension by 48-h ABP monitoring was very high (84.3%) and close to that by pre-haemodialysis BP (89.4%) but the agreement of the two techniques was not of the same magnitude (κ statistics = 0.648; P <0.001). In all, 290 participants were receiving antihypertensive treatment. In all, 9.1% of haemodialysis patients were categorized as normotensives, 12.6% had controlled hypertension confirmed by the two BP techniques, while 46.0% had uncontrolled hypertension with both techniques. The prevalence of white coat hypertension was 18.2% and that of masked hypertension 14.1%. Of note, hypertension was confined only to night-time in 22.2% of patients while just 1% of patients had only daytime hypertension. Pre-dialysis BP ≥140/90 mmHg had 76% sensitivity and 54% specificity for the diagnosis of BP ≥130/80 mmHg by 48-h ABP monitoring.
The prevalence of hypertension in haemodialysis patients assessed by 48-h ABP monitoring is very high. Pre-haemodialysis BP poorly reflects the 48 h-ABP burden. About a third of the haemodialysis population has white coat or masked hypertension. These findings add weight to consensus documents supporting the use of ABP monitoring for proper hypertension diagnosis and treatment in this population.
特定人群的共识文件建议，对血液透析患者的高血压诊断应基于 48 小时动态血压（ABP）监测。然而，到目前为止，在美国只有一项关于使用 44 小时记录评估血液透析患者高血压患病率的研究。由于欧洲国家在这个问题上存在知识空白，我们在欧洲心血管和肾脏医学工作组、欧洲肾脏协会-欧洲透析和移植协会注册处重新评估了这个问题。
共有 396 名血液透析患者在常规血液透析期间和随后的透析间期进行了 48 小时 ABP 监测。高血压的定义为（i）透析前血压（BP）≥140/90mmHg 或使用抗高血压药物，和（ii）ABP≥130/80mmHg 或使用抗高血压药物。
48 小时 ABP 监测的高血压患病率非常高（84.3%），与透析前 BP （89.4%）非常接近，但两种技术的一致性并不相同（κ 统计=0.648；P<0.001）。共有 290 名参与者正在接受抗高血压治疗。共有 9.1%的血液透析患者被归类为血压正常者，12.6%的患者两种 BP 技术均证实高血压得到控制，而 46.0%的患者两种技术均显示高血压未得到控制。白大衣高血压的患病率为 18.2%，隐蔽性高血压的患病率为 14.1%。值得注意的是，只有 22.2%的患者高血压仅局限于夜间，而只有 1%的患者只有日间高血压。透析前 BP≥140/90mmHg 对诊断 48 小时 ABP 监测时 BP≥130/80mmHg 的敏感度为 76%，特异性为 54%。
通过 48 小时 ABP 监测评估的血液透析患者高血压患病率非常高。透析前 BP 不能很好地反映 48 小时 ABP 负荷。大约三分之一的血液透析患者存在白大衣或隐蔽性高血压。这些发现支持共识文件，即支持在该人群中使用 ABP 监测进行适当的高血压诊断和治疗。
