Pontifícia Universidade Católica do Paraná, Curitiba, Brazil.
Fundação PróRim, Joinville, Brazil.
Hemodial Int. 2020 Jul;24(3):397-405. doi: 10.1111/hdi.12829. Epub 2020 Mar 10.
Hypertension is multifactorial, highly prevalent in the hemodialysis (HD) population and its adequate control requires, in addition to adequate volume management, often the use of multiple antihypertensive drugs. We aimed to describe the use of antihypertensive agents in a group of HD patients and to evaluate the factors associated with the use of multiple classes (≥3) of antihypertensives.
We analyzed the baseline data from the HDFit study. Clinically stable patients with HD vintage between 3 and 24 months without any severe mobility limitation were recruited from sites throughout southern Brazil. Fluid status was measured pre-dialysis with the Body Composition Monitor (BCM; Fresenius, Germany). Fluid overload (FO) was considered when the overhydration index (OH) was greater than 7% of extracellular water (OH/ECW > 7%) and overweight was defined as a body mass index (BMI) greater than 25 kg/m . Prescriptions of antihypertensive drugs were obtained from participants' reports and medical records. Logistic regression was employed to determine factors associated with excessive use of antihypertensive medication (≥3 classes).
Of 195 studied patients, 171 with complete data were included (70% male, 53 ± 15 years old, 57% of them with FO). Pre-dialysis systolic blood pressure (SBP) was 150 ± 24 mmHg and patients used a median of 2 (1-3) antihypertensive drugs. Vasodilators (20%) were of lowest prevalence, use of other classes varied from 40% to 53%. Sixty-two (36%) subjects used ≥3 classes and presented a higher prevalence of diabetes and FO, lower prevalence of overweight, and higher SBP. In a logistic regression model age, BMI <25 kg/m , and OH/ECW > 7% were associated with excessive drug use.
More than one-third of participants used ≥3 classes of antihypertensive drugs, and it was associated with older age, BMI <25 kg/m and FO. Strategies that better manage FO may aid better blood pressure control and avoid the use of multiple antihypertensive medications.
高血压是多因素的，在血液透析（HD）人群中患病率很高，除了适当的容量管理外，通常还需要使用多种降压药物来控制血压。我们旨在描述一组 HD 患者中降压药物的使用情况，并评估与使用多种（≥3 种）降压药物相关的因素。
我们分析了 HDFit 研究的基线数据。从巴西南部各地的站点招募了具有 3 至 24 个月 HD 病史且无严重活动能力受限的临床稳定患者。使用 Fresenius 公司的 Body Composition Monitor（BCM）在透析前测量液体状态。当水过多指数（OH）大于细胞外液的 7%（OH/ECW > 7%）时，认为存在液体超负荷（FO），超重定义为 BMI 大于 25kg/m。从参与者的报告和病历中获得降压药物的处方。使用逻辑回归确定与过度使用降压药物（≥3 种）相关的因素。
在 195 名研究患者中，有 171 名患者（70%为男性，53±15 岁，57%存在 FO）完成了全部数据。透析前收缩压（SBP）为 150±24mmHg，患者使用中位数为 2（1-3）种降压药物。血管扩张剂（20%）的使用率最低，其他类别的使用率在 40%至 53%之间。62 名（36%）患者使用≥3 种药物，且糖尿病和 FO 的发生率更高，超重的发生率更低，SBP 更高。在逻辑回归模型中，年龄、BMI <25kg/m和 OH/ECW > 7%与过度用药相关。
超过三分之一的参与者使用了≥3 种降压药物，这与年龄较大、BMI<25kg/m 和 FO 有关。更好地管理 FO 的策略可能有助于更好地控制血压并避免使用多种降压药物。
