波兰血液透析人群中貌似难治性高血压：患病率及危险因素

Apparently Resistant Hypertension in Polish Hemodialyzed Population: Prevalence and Risk Factors.

作者信息

Symonides Bartosz, Lewandowski Jacek, Marcinkowski Wojciech, Zawierucha Jacek, Prystacki Tomasz, Małyszko Jolanta

机构信息

Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland.

Fresenius Medical Care, 60-118 Poznań, Poland.

出版信息

J Clin Med. 2023 Aug 20;12(16):5407. doi: 10.3390/jcm12165407.

DOI:10.3390/jcm12165407

PMID:37629449

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10455257/

Abstract

BACKGROUND

The aim of this study was to assess the prevalence, characteristics, and determinants of apparent treatment-resistant hypertension (aTRH) in an unselected large population of patients with end-stage kidney disease (ESKD) treated with hemodialysis (HD) throughout the country.

METHODS

A database of 5879 patients (mean age 65.2 ± 14.2 years, 60% of males receiving hemodialysis) was obtained from the biggest provider of hemodialysis in the country. Hypertension and aTRH were defined using pre- or/and post-dialysis BP values. Patients with and without aTRH (non-aTRH) were compared.

RESULTS

Using pre- and post-dialysis criteria, hypertension was diagnosed in 90.7% and 89.1% of subjects, respectively. According to pre- and post-dialysis blood pressure criteria, aTRH incidences were 40.9% and 38.4%, respectively. The hypertensive patients with aTRH versus non-aTRH were younger, had a higher rate of cardiovascular disease, lower dialysis vintage, shorter time on dialysis, higher eKt/V, higher ultrafiltration, higher pre- and post-dialysis BP and HR, and higher use of antihypertensive drugs. Factors that increase the risk of aTRH according to both pre- and post-dialysis BP criteria were age-OR 0.99 [0.98-0.99] and 0.99 [0.98-0.99], the history of CVD 1.26 [1.08-1.46] and 1.30 [1.12-1.51], and diabetes 1.26 [1.08-1.47] and 1.28 [1.09-1.49], adjusted OR with 95% CI.

CONCLUSIONS

In the real-life world, as much as 40% of HD patients may have aTRH. In ESKD HD patients, aTRH seems to be multifactorial, influenced by patient-related rather than dialysis-related factors. Various definitions of aTRH preclude easy comparisons between studies.

摘要

背景

本研究旨在评估全国范围内接受血液透析（HD）治疗的未选择的终末期肾病（ESKD）患者中，貌似难治性高血压（aTRH）的患病率、特征及决定因素。

方法

从该国最大的血液透析服务提供商处获取了一个包含5879例患者（平均年龄65.2±14.2岁，60%接受血液透析的为男性）的数据库。高血压和aTRH通过透析前或/和透析后血压值来定义。对有和没有aTRH（非aTRH）的患者进行比较。

结果

采用透析前和透析后标准，分别有90.7%和89.1%的受试者被诊断为高血压。根据透析前和透析后血压标准，aTRH的发生率分别为40.9%和38.4%。患有aTRH的高血压患者与非aTRH患者相比更年轻，心血管疾病发生率更高，透析龄更低，透析时间更短，Kt/V更高，超滤量更高，透析前和透析后血压及心率更高，使用降压药物的比例更高。根据透析前和透析后血压标准，增加aTRH风险的因素有年龄，OR分别为0.99 [0.98 - 0.99]和0.99 [0.98 - 0.99]，心血管疾病史为1.26 [1.08 - 1.46]和1.30 [1.12 - 1.51]，糖尿病为1.26 [1.08 - 1.47]和1.28 [1.09 - 1.49]，校正OR及95%可信区间。