Hospital das Clínicas, Heart Institute (InCor), University of São Paulo Medical School, Rua Eneas Carvalho Aguiar, 44, São Paulo, SP, 05403-000, Brazil.
Renal Transplant Unit, Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, SP, Brazil.
High Blood Press Cardiovasc Prev. 2023 May;30(3):235-241. doi: 10.1007/s40292-023-00575-4. Epub 2023 Apr 26.
Normal (120-140 mm Hg) systolic peridialysis blood pressure (BP) is associated with higher mortality in hemodialysis (HD) patients.
We explored the relationship between hypertension and BP on outcomes using data collected at the interdialytic period.
This was a single-center observational cohort study with 2672 HD patients. BP was determined at inception, in mid-week, between 2 consecutive dialysis sessions. Hypertension was defined as systolic BP ≥ 140 mm Hg and/or diastolic BP ≥ 90 mm Hg. Endpoints were major CV events and all-cause mortality.
During a median follow-up of 31 months, 761 patients (28%) experienced CV events and 1181 (44%) died. Hypertensive patients had lower survival free of CV than normotensive patients (P = 0.031). No difference occurred in the incidence of death between groups. Compared with the reference category of SBP ≥ 171 mmHg, the incidence of cardiovascular events was reduced in patients with SBP 101-110 (HR 0.647, 95% CI 0.455 to 0.920), 111-120 (HR 0.663, 95%CI 0.492 to 0.894), 121-130 (HR 0.747, 95%CI 0.569 to 0.981), and 131-140 (HR 0.757, 95%CI 0.596 to 0.962). On multivariate analysis, systolic and diastolic BP were not independent predictors of CV events or death. Normal interdialytic BP was not associated with mortality or CV events, and hypertension predicted an increased probability of CV complications.
Interdialytic BP may be preferred to guide treatment decisions, and HD patients should be treated according to guidelines for the general population until specific BP targets for this population are identified.
正常（120-140mmHg）的透析间期收缩压（BP）与血液透析（HD）患者的死亡率升高有关。
我们使用透析间期收集的数据探讨了高血压与 BP 对结局的关系。
这是一项单中心观察性队列研究，纳入了 2672 例 HD 患者。BP 在起始时、每周中间、两次连续透析之间进行测定。高血压定义为收缩压≥140mmHg 和/或舒张压≥90mmHg。终点是主要心血管事件和全因死亡率。
在中位 31 个月的随访期间，761 例患者（28%）发生心血管事件，1181 例患者（44%）死亡。与血压正常患者相比，高血压患者无心血管事件的生存率较低（P=0.031）。两组之间的死亡率无差异。与收缩压≥171mmHg 的参考类别相比，收缩压为 101-110mmHg（HR 0.647，95%CI 0.455 至 0.920）、111-120mmHg（HR 0.663，95%CI 0.492 至 0.894）、121-130mmHg（HR 0.747，95%CI 0.569 至 0.981）和 131-140mmHg（HR 0.757，95%CI 0.596 至 0.962）的患者心血管事件发生率降低。多变量分析显示，收缩压和舒张压不是心血管事件或死亡的独立预测因素。正常透析间期 BP 与死亡率或心血管事件无关，高血压预示着心血管并发症的发生概率增加。
透析间期 BP 可能更适合指导治疗决策，在为该人群确定具体 BP 目标之前，应根据针对普通人群的指南对 HD 患者进行治疗。
