Faye Maria, Faye Moustapha, Lemrabott Ahmed Tall, Cisse Mouhamadou Moustapha, Fall Kodia, Ismael Keita Alex Rich, Mbengue Mansour, Ba Bacary, Keita Niakhaleen, Diagne Seynabou, Niang Abdou, Diouf Boucar, Ka El Hadji Fary
Department of Nephrology, Cheikh Anta Diop University; Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal.
Department of Nephrology, Aristide Le Dantec University Hospital, Dakar, Senegal.
Saudi J Kidney Dis Transpl. 2019 Sep-Oct;30(5):1038-1043. doi: 10.4103/1319-2442.270258.
The monitoring of hypertension (HTN) in dialysis is often delicate with potentially false measurements due to the white coat effect on the one hand and masked HTN (M-HTN) on the other hand. In this population, there is much controversy over the ideal moment for taking blood pressure (BP) and the target values. An answer to these questions is given by home BP measurement that can detect white coat HTN (WC-HTN) and M-HTN. The aim of this study was to determine the respective prevalence of permanent HTN (P-HTN), WC-HTN, M-HTN, and permanently normotensive (P-NTN) in this population and to analyze the risk factors of M-HTN and WC-HTN in hemodialysis (HD) centers in sub-Saharan Africa. This was a multicenter, descriptive, and analytical cross-sectional study conducted over a period of one month and 23 days. Data collection was performed using a home BP measurement form, conventional BP measurement form, and clinical and laboratory data collection form. The study included all patients who could take their BP at home using an electronic BP machine and record results on the BP forms. All analyses were performed using the Sphinx plus software version 5. The significance level for all statistical tests was set at 5%. The mean age of patients was 45.57 years ± 14.11, with a sex ratio of 1.42. The mean duration in dialysis was 57.96 months ± 34.86. Adherence to the home BP measurement was 100% in 71.7%. P-NTN patients were 15.2% (7 patients), WC-HTN patients were 13% (6 patients), M-HTN patients were 17.5% (8 patients), and P-HTN patients were 54.3% (25 patients). A statistically significant association was observed between WC-HTN and age (P = 0.01). In this work, we noted an important proportion of M-HTN and WC-HTN. This result confirms the need for home BP measurement in the follow-up of BP in HD patients.
在透析过程中监测高血压(HTN)往往很棘手,一方面存在白大衣效应导致潜在的测量误差,另一方面存在隐匿性高血压(M-HTN)。在这一人群中,关于测量血压(BP)的理想时机和目标值存在诸多争议。家庭血压测量能够检测出白大衣高血压(WC-HTN)和M-HTN,从而为这些问题提供了答案。本研究的目的是确定该人群中持续性高血压(P-HTN)、WC-HTN、M-HTN和持续性血压正常(P-NTN)的各自患病率,并分析撒哈拉以南非洲血液透析(HD)中心M-HTN和WC-HTN的危险因素。这是一项多中心、描述性和分析性横断面研究,为期1个月零23天。数据收集使用家庭血压测量表、传统血压测量表以及临床和实验室数据收集表。该研究纳入了所有能够在家中使用电子血压计测量血压并将结果记录在血压表上的患者。所有分析均使用Sphinx plus软件版本5进行。所有统计检验的显著性水平设定为5%。患者的平均年龄为45.57岁±14.11岁,性别比为1.42。透析的平均时长为57.96个月±34.86个月。71.7%的患者对家庭血压测量的依从率为100%。P-NTN患者占15.2%(7例),WC-HTN患者占13%(6例),M-HTN患者占17.5%(8例),P-HTN患者占54.3%(25例)。观察到WC-HTN与年龄之间存在统计学显著关联(P = 0.01)。在本研究中,我们注意到M-HTN和WC-HTN占比很大。这一结果证实了在HD患者血压随访中进行家庭血压测量的必要性。