Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642, Thessaloniki, Greece.
Therapeutiki Hemodialysis Unit, Thessaloniki, Greece.
J Nephrol. 2022 Apr;35(3):943-954. doi: 10.1007/s40620-021-01205-9. Epub 2022 Jan 6.
Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysis patients due to its strong association with outcomes. Intradialytic and scheduled interdialytic BP recordings show agreement with ambulatory BP. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events.
We prospectively followed 242 hemodialysis patients with valid 48-h ABPMs for a median of 45.7 months to examine the association of pre-dialysis, intradialytic, intradialytic plus pre/post-dialysis readings, scheduled interdialytic BP, and 44-h ambulatory BP with outcomes. The primary end-point was a composite one, composed of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, resuscitation after cardiac arrest, hospitalization for heart failure, coronary revascularization procedure or peripheral revascularization procedure.
Cumulative freedom from the primary end-point was significantly lower with increasing 44-h SBP (group 1, < 120 mmHg, 64.2%; group 2, ≥ 120 to < 130 mmHg 60.4%, group 3, ≥ 130 to < 140 mmHg 45.3%; group 4, ≥ 140 mmHg 45.5%; logrank-p = 0.016). Similar were the results for intradialytic (logrank-p = 0.039), intradialytic plus pre/post-dialysis (logrank-p = 0.044), and scheduled interdialytic SBP (logrank-p = 0.030), but not for pre-dialysis SBP (logrank-p = 0.570). Considering group 1 as the reference group, the hazard ratios of the primary end-point showed a gradual increase with higher BP levels with all BP metrics, except pre-dialysis SBP. This pattern was confirmed in adjusted analyses. An inverse association of DBP levels with outcomes was shown with all BP metrics, which was no longer evident in adjusted analyses.
Averaged intradialytic and scheduled home BP measurements (but not pre-dialysis readings) display similar prognostic associations with 44-h ambulatory BP in hemodialysis patients and represent valid metrics for hypertension management in these individuals.
由于与结果具有很强的关联性，动态血压监测（ABPM）被推荐用于诊断和管理血液透析患者的高血压。透析内和计划的透析间血压记录与 ABPM 一致。本研究平行评估了透析前、透析内、计划的透析间和 ABPM 记录与心血管事件的关联。
我们前瞻性地随访了 242 名接受了 48 小时 ABPM 检查的血液透析患者，中位随访时间为 45.7 个月，以检查透析前、透析内、透析内加前后透析读数、计划的透析间血压和 44 小时动态血压与结局的关系。主要终点是一个复合终点，包括心血管死亡、非致死性心肌梗死、非致死性卒中和心脏骤停后的复苏、心力衰竭住院、冠状动脉血运重建或外周血运重建。
随着 44 小时 SBP 的增加，主要终点的累积无事件率显著降低（组 1，<120mmHg，64.2%；组 2，≥120 至<130mmHg，60.4%；组 3，≥130 至<140mmHg，45.3%；组 4，≥140mmHg，45.5%；logrank-p=0.016）。透析内（logrank-p=0.039）、透析内加前后（logrank-p=0.044）和计划的透析间 SBP（logrank-p=0.030）的结果也相似，但透析前 SBP 的结果却不同（logrank-p=0.570）。以组 1 作为参考组，除透析前 SBP 外，所有 BP 指标的主要终点的风险比均随着 BP 水平的升高而逐渐升高。这一模式在调整分析中得到了证实。所有 BP 指标均显示 DBP 水平与结局呈负相关，但在调整分析中这一相关性不再明显。
透析内和计划的家庭血压测量（但不是透析前读数）与血液透析患者的 44 小时动态血压具有相似的预后相关性，是这些患者高血压管理的有效指标。
