Symonides Bartosz, Lewandowski Jacek, Marcinkowski Wojciech, Zawierucha Jacek, Prystacki Tomasz, Małyszko Jolanta
Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland.
Fresenius Medical Care, 60-118 Poznań, Poland.
J Clin Med. 2023 Aug 20;12(16):5407. doi: 10.3390/jcm12165407.
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.
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.
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.
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.
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。
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。
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。
在现实世界中，多达40%的HD患者可能患有aTRH。在ESKD HD患者中，aTRH似乎是多因素的，受患者相关因素而非透析相关因素影响。aTRH的各种定义使得不同研究之间难以进行简单比较。
