动态血压与腹膜透析患者全因死亡率及心血管结局的关系。

Association of Ambulatory Blood Pressure with All-Cause Mortality and Cardiovascular Outcomes in Peritoneal Dialysis Patients.

机构信息

Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China.

Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China,

出版信息

Kidney Blood Press Res. 2020;45(6):890-899. doi: 10.1159/000510298. Epub 2020 Dec 2.

DOI:10.1159/000510298

PMID:33264789

Abstract

BACKGROUND

Ambulatory blood pressure monitoring is the gold standard for the diagnosis of hypertension, but its effects on all-cause mortality and cardiovascular outcomes in peritoneal dialysis (PD) patients remain uncertain. We aimed to investigate the association between ambulatory blood pressure and clinical outcomes in PD patients.

METHODS

A prospective, observational cohort study was conducted in PD patients enrolled from March 2001 to July 2018 and followed until October 2019. Blood pressure was evaluated using 24-h ambulatory blood pressure monitoring. The endpoints included all-cause mortality, cardiovascular mortality, and cardiovascular events. Multivariable Cox regression was used to identify the associations between ambulatory blood pressure and endpoints. Subsequently, multivariable logistic regression was conducted to identify factors associated with elevated pulse pressure (PP).

RESULTS

A total of 260 PD patients (154 men, 59.2%) were recruited. The median follow-up duration was 40.7 months. Our studies revealed that PP was an independent predictor of all-cause mortality (hazard ratio [HR], 1.018; 95% CI, 1.001-1.034; p = 0.032), cardiovascular mortality (HR, 1.039; 95% CI, 1.017-1.061; p < 0.001), and cardiovascular events (HR, 1.028; 95% CI, 1.011-1.046; p = 0.001). Systolic blood pressure was an independent predictor of cardiovascular mortality (HR, 1.023; 95% CI, 1.007-1.040; p = 0.005) and cardiovascular events (HR, 1.018; 95% CI, 1.006-1.030; p = 0.003). Vascular calcification was significantly associated with elevated PP (OR, 3.069; 95% CI, 1.632-5.772; p = 0.001).

CONCLUSION

24-h ambulatory PP was the most significant predictor of all blood pressure indicators for clinical outcomes in PD patients.

摘要

背景

动态血压监测是诊断高血压的金标准，但在腹膜透析（PD）患者中，其对全因死亡率和心血管结局的影响仍不确定。我们旨在研究 PD 患者的动态血压与临床结局之间的关系。

方法

这是一项从 2001 年 3 月至 2018 年 7 月招募并随访至 2019 年 10 月的前瞻性观察性队列研究。使用 24 小时动态血压监测评估血压。终点包括全因死亡率、心血管死亡率和心血管事件。多变量 Cox 回归用于确定动态血压与终点之间的关系。随后，进行多变量逻辑回归以确定与脉压升高相关的因素。

结果

共纳入 260 例 PD 患者（男 154 例，59.2%）。中位随访时间为 40.7 个月。我们的研究表明，脉压是全因死亡率（危险比[HR]，1.018；95%置信区间，1.001-1.034；p = 0.032）、心血管死亡率（HR，1.039；95%置信区间，1.017-1.061；p < 0.001）和心血管事件（HR，1.028；95%置信区间，1.011-1.046；p = 0.001）的独立预测因素。收缩压是心血管死亡率（HR，1.023；95%置信区间，1.007-1.040；p = 0.005）和心血管事件（HR，1.018；95%置信区间，1.006-1.030；p = 0.003）的独立预测因素。血管钙化与脉压升高显著相关（OR，3.069；95%置信区间，1.632-5.772；p = 0.001）。