肾移植受者的血压治疗——我们能否改进？

Blood Pressure Treatment in Kidney Transplant Recipients-Can We Improve?

作者信息

Onsøien Mari O, Midtvedt Karsten, Reisæter Anna V, Aasarød Knut, Waldum-Grevbo Bård, Vikse Bjørn Egil, Eriksen Bjørn Odvar, Åsberg Anders

机构信息

Faculty of Medicine, University of Oslo, Oslo, Norway.

Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway.

出版信息

Transplant Direct. 2021 Mar 25;7(4):e688. doi: 10.1097/TXD.0000000000001142. eCollection 2021 Apr.

DOI:10.1097/TXD.0000000000001142

PMID:33786373

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7997102/

Abstract

UNLABELLED

Hypertension in kidney transplant (KTx) recipients is common, affecting both patient and graft survival. Annual data from the Norwegian Renal Registry reveal that <50% of adult (>18 y) KTx recipients reach target blood pressure (BP) ≤130/80 mm Hg. The aim of this study was to identify the determinants of failure to achieve BP control.

METHODS

In conjunction with the 2018 annual data reporting, additional questions were added for recipients with BP >130/80 mm Hg (treating physician´s target BP for each patient, reasons for not achieving target, method of measurement).

RESULTS

Annual forms were received from 98% (3407 of 3486) of KTx recipients, with 1787 (52%) reporting a BP >130/80 mm Hg ("above-target" group). These recipients were older, mostly male, with higher body mass index and serum creatinine levels ( < 0.05) compared with patients with controlled hypertension ("on-target" group). Valid survey answers were available for 84% of the "above-target" group (Surv) with no significant demographic differences versus nonresponders (Surv). Among Surv, 32% were under antihypertensive dose titration, whereas dose-limiting side effects were reported in 7%. Target BP was confirmed to 130/80 mm Hg for 60% of Surv. In recipients for whom the treating physician set target BP >130/80 mm Hg, 51% did not reach these individual targets. The number of antihypertensive drugs was significantly higher in the "above-target" group versus "on-target" group (mean 2.1 ± 1.2 versus 1.8 ± 1.3) and 36% versus 25% used ≥3 antihypertensive drugs ( < 0.05). Automatic attended BP measurement was utilized by 51%.

CONCLUSIONS

In KTx recipients, a higher BP target achievement seems possible, potentially in the range of 75%-80%.

摘要

未标注

肾移植（KTx）受者中高血压很常见，影响患者和移植物的存活。挪威肾脏登记处的年度数据显示，年龄≥18岁的成年KTx受者中，不到50%的人血压（BP）能达到目标值≤130/80 mmHg。本研究的目的是确定血压控制未达标的决定因素。

方法

在2018年年度数据报告时，对血压>130/80 mmHg的受者增加了额外问题（每位患者的治疗医生设定的目标血压、未达标的原因、测量方法）。

结果

收到了98%（3486例中的3407例）KTx受者的年度表格，其中1787例（52%）报告血压>130/80 mmHg（“高于目标”组）。与血压控制良好的患者（“达标”组）相比，这些受者年龄更大，大多为男性，体重指数和血清肌酐水平更高（P<0.05）。“高于目标”组中84%（Surv）有有效的调查答案，与未应答者相比，人口统计学上无显著差异（Surv）。在Surv中，32%正在进行降压药物剂量滴定，而7%报告有剂量限制副作用。60%的Surv的目标血压被确认为130/80 mmHg。在治疗医生设定目标血压>130/80 mmHg的受者中，51%未达到这些个人目标。“高于目标”组的降压药物数量显著高于“达标”组（平均2.1±1.2种与1.8±1.3种），使用≥3种降压药物的比例分别为36%和25%（P<0.05）。51%的人使用自动辅助血压测量。