Georgianos Panagiotis I, Vaios Vasilios, Zebekakis Pantelis E, Liakopoulos Vassilios
Peritoneal Dialysis Unit, 1st Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, GR54636 Thessaloniki, Greece.
J Clin Med. 2021 May 21;10(11):2232. doi: 10.3390/jcm10112232.
Large observational studies showed a U-shaped association of clinic blood pressure (BP) with mortality among patients undergoing peritoneal dialysis (PD). Whether ambulatory BP provides a more direct risk signal in this population remains unknown. In a prospective cohort of 108 PD patients, standardized clinic BP was recorded at baseline with the validated device HEM-705 (Omron, Healthcare, Bannockburn, IL, USA) and 24-h ambulatory BP monitoring was performed using the Mobil-O-Graph monitor (IEM, Stolberg, Germany). Over a median follow-up of 16 months (interquartile range: 19 months), 47.2% of the overall population reached the composite outcome of non-fatal myocardial infarction, non-fatal stroke, or all-cause death. In Cox-regression analysis, systolic but not diastolic BP was prognostically informative. Compared with the reference quartile 1 of 24-h systolic BP (SBP), the multivariate-adjusted hazard ratio for the composite outcome was 1.098 (95% confidence interval (CI): 0.434-2.777) in quartile 2, 1.004 (95% CI: 0.382-2.235) in quartile 3 and 2.449 (95% CI: 1.156-5.190) in quartile 4. In contrast, no such association was observed between increasing quartiles of clinic SBP and composite outcome. The present study shows that among PD patients, increasing ambulatory SBP is independently associated with higher risk of adverse cardiovascular events and mortality, providing superior prognostic information than standardized clinic SBP.
大型观察性研究表明，在接受腹膜透析（PD）的患者中，临床血压（BP）与死亡率呈U型关联。动态血压是否能为该人群提供更直接的风险信号尚不清楚。在一项对108例PD患者的前瞻性队列研究中，使用经过验证的HEM-705设备（欧姆龙医疗保健公司，美国伊利诺伊州班诺克本）在基线时记录标准化临床血压，并使用Mobil-O-Graph监测仪（德国斯托尔伯格的IEM公司）进行24小时动态血压监测。在中位随访16个月（四分位间距：19个月）期间，47.2%的总体人群达到了非致命性心肌梗死、非致命性中风或全因死亡的复合结局。在Cox回归分析中，收缩压而非舒张压具有预后信息价值。与24小时收缩压（SBP）的参考四分位数1相比，复合结局的多变量调整风险比在四分位数2中为1.098（95%置信区间（CI）：0.434 - 2.777），在四分位数3中为1.004（95%CI：0.382 - 2.235），在四分位数4中为2.449（95%CI：1.156 - 5.190）。相比之下，临床SBP四分位数增加与复合结局之间未观察到此类关联。本研究表明，在PD患者中，动态SBP升高与不良心血管事件和死亡风险较高独立相关，比标准化临床SBP提供了更好的预后信息。
