Department of Nephrology, Peking University People's Hospital, Beijing, China.
Department of Nephrology, Miyun Hospital, Beijing, China.
Ren Fail. 2022 Dec;44(1):1811-1818. doi: 10.1080/0886022X.2022.2136527.
Hypertension is a leading preventable risk factor for cardiovascular disease in hemodialysis patients. Pre-dialysis systolic blood pressure (SBP) more than 160 mmHg was thought to be associated with increased risk of cardiovascular events and all-cause mortality. The present study was performed to explore the clinical characteristics and management of hemodialysis patients with pre-dialysis SBP ≥ 160 mmHg.
A total of 1233 patients undergoing hemodialysis from nine hemodialysis centers were enrolled. Pre-dialysis and home BP were measured and clinical data were collected. The characteristics of patients with pre-dialysis SBP ≥ 160 mmHg were explored. Clinical parameters between hypertensive and non-hypertensive patients were compared. The partial correlation analyses performed to identify the associations between BP and clinical parameters.
There were 24.6% of the hemodialysis patients had pre-dialysis SBP ≥ 160 mmHg and the average SBP was 173.8 ± 10.9 mmHg. Only 21.4% of the patients achieved dry weight after dialysis and up to 30.2% of patients were not given combination therapies of antihypertensive drugs. Compared to patients with pre-hemodialysis SBP < 160 mmHg, patients with pre-dialysis SBP ≥ 160 mmHg had lower target-reaching rate of Kt/v and higher incidences of intradialytic hypotension and muscle spasm. Most patients (96%) with pre-dialysis SBP ≥ 160 mmHg had home SBP≥ 135 mmHg. Patients with home SBP ≥ 160 mmHg had higher left ventricular weight index and lower hemoglobin levels when compared to their counterparts with home SBP <160 mmHg.
Pre-dialysis SBP ≥ 160 mmHg is common in clinical practice and most of the patients could diagnosed to be hypertensive according to their home SBP. Patients with pre-dialysis SBP ≥ 160 mmHg are more likely to be subjected to dialysis insufficiency and intradialytic complications. Achieving dry weight and sufficient pharmacologic interventions should be strengthened to improve BP control in the hemodialysis population.
高血压是血液透析患者心血管疾病的主要可预防风险因素。透析前收缩压（SBP）超过 160mmHg 被认为与心血管事件和全因死亡率的增加有关。本研究旨在探讨透析前 SBP≥160mmHg 的血液透析患者的临床特征和管理。
共纳入来自 9 家血液透析中心的 1233 名血液透析患者。测量透析前和家庭血压，并收集临床数据。探讨了透析前 SBP≥160mmHg 患者的特征。比较了高血压和非高血压患者的临床参数。进行偏相关分析以确定 BP 与临床参数之间的关联。
24.6%的血液透析患者透析前 SBP≥160mmHg，平均 SBP 为 173.8±10.9mmHg。仅 21.4%的患者在透析后达到干体重，多达 30.2%的患者未接受降压药物联合治疗。与透析前 SBP<160mmHg 的患者相比，透析前 SBP≥160mmHg 的患者达到 Kt/v 目标的比例较低，发生透析中低血压和肌肉痉挛的比例较高。大多数（96%）透析前 SBP≥160mmHg 的患者家庭 SBP≥135mmHg。与家庭 SBP<160mmHg 的患者相比，家庭 SBP≥160mmHg 的患者左心室重量指数较高，血红蛋白水平较低。
透析前 SBP≥160mmHg 在临床实践中很常见，根据家庭 SBP 大多数患者可被诊断为高血压。透析前 SBP≥160mmHg 的患者更容易出现透析不足和透析中并发症。应加强达到干体重和充分的药物干预，以改善血液透析人群的血压控制。
