血压管理与肾移植的长期预后：35 年的整体观察

Blood pressure management and long-term outcomes in kidney transplantation: a holistic view over a 35-year period.

机构信息

Hôpital Bretonneau, Néphrologie-Immunologie Clinique, CHU Tours, Tours, France.

EA4245, University of Tours, Tours, France.

出版信息

J Nephrol. 2023 Sep;36(7):1931-1943. doi: 10.1007/s40620-023-01706-9. Epub 2023 Aug 7.

DOI:10.1007/s40620-023-01706-9

PMID:37548826

Abstract

INTRODUCTION

Hypertension is a burden for most kidney transplant recipients. Whether respect of hypertension guidelines results in better outcomes is unknown.

METHODS

In this multicenter study, office blood pressure at 12 months following transplantation (i.e., after > 20 outpatient visits), and survival were assessed over 35 years among 2004 consecutive kidney transplant recipients who received a first kidney graft from 1985 to 2019 (follow-up: 26,232 patient-years).

RESULTS

Antihypertensive medications were used in 1763/2004 (88.0%) patients. Renin-angiotensin-system blockers were used in 35.6% (47.1% when proteinuria was > 0.5 g/day) and calcium-channel blockers were used in 6.0% of patients. Combined treatment including renin-angiotensin-system-blockers, calcium-channel blockers and diuretics was used in 15.4% of patients receiving ≥ 3 antihypertensive drugs. Blood pressure was controlled in 8.3%, 18.8% and 43.1%, respectively, depending on definition (BP < 120/80, < 130/80, < 140/90 mmHg, respectively) and has not improved since the year 2001. Two-thirds of patients with uncontrolled blood pressure received < 3 antihypertensive classes. Low sodium intake < 2 g/day (vs ≥ 2) was not associated with better blood pressure control. Uncontrolled blood pressure was associated with lower patient survival (in multivariable analyses) and graft survival (in univariate analyses) vs controlled hypertension or normotension. Low sodium intake and major antihypertensive classes had no influence on patient and graft survival.

CONCLUSIONS

Pharmacological recommendations and sodium intake reduction are poorly respected, but even when respected, do not result in better blood pressure control, or patient or graft survival. Uncontrolled blood pressure, not the use of specific antihypertensive classes, is associated with reduced patient, and to a lesser extent, reduced graft survival, even using the 120/80 mmHg cut-off.

摘要

简介

高血压是大多数肾移植受者的负担。是否遵守高血压指南会带来更好的结果尚不清楚。

方法

在这项多中心研究中，评估了 2004 例连续接受肾移植的患者（1985 年至 2019 年期间接受首次肾移植）在移植后 12 个月（即 20 多次门诊就诊后）的诊室血压和 35 年的生存情况（随访：26232 患者年）。

结果

1763/2004（88.0%）例患者使用了降压药物。肾素-血管紧张素系统阻滞剂的使用率为 35.6%（蛋白尿>0.5g/天时为 47.1%），钙通道阻滞剂的使用率为 6.0%。使用≥3 种降压药物的患者中有 15.4%联合使用了肾素-血管紧张素系统阻滞剂、钙通道阻滞剂和利尿剂。根据定义（血压<120/80、<130/80、<140/90mmHg），血压控制率分别为 8.3%、18.8%和 43.1%，且自 2001 年以来并无改善。三分之二血压未控制的患者接受了<3 种降压药。与更好的血压控制相比，低钠摄入量<2g/天（<2g/天）与血压控制不佳无关。与血压控制良好或血压正常相比，血压未控制与患者生存率（多变量分析）和移植物生存率（单变量分析）降低相关。低钠摄入和主要降压类别对患者和移植物生存率均无影响。