Division of Cardiology, Nephrology, Respiratory, and Neurology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan.
J Clin Hypertens (Greenwich). 2023 Dec;25(12):1163-1171. doi: 10.1111/jch.14736. Epub 2023 Oct 27.
The prevalence of hypertension is high among patients undergoing dialysis. We extracted data of patients undergoing dialysis between 2012 and 2020 with recorded pre-dialysis systolic blood pressure (SBP) using a web-based national database in Japan. Following the 2019 Japanese Society of Hypertension guidelines, we classified SBP and assessed its trends over time based on sex, age, diabetes status, and the anti-hypertensive medication use. Using the 2020 database, we examined 336,759 Japanese patients undergoing dialysis (114,249 female; 222,510 male). The mean age was 69.4 ± 12.5 years, and the mean SBP was 152.3 ± 24.7 mm Hg. The prevalence rate of pre-dialysis hypertension was 70.2%, with 32.5%, 24.5%, and 13.2% of patients having grade I, grade II, and grade III hypertension, respectively. From 2014 to 2020, prevalence rate of pre-dialysis hypertension and absolute values of pre-dialysis SBP were higher in dialysis patients with diabetes than in those without diabetes across all age groups and sexes. Younger patients with diabetes or those on anti-hypertensive medication exhibited an SBP of approximately 160 mm Hg. Cerebrovascular death in patients with diabetes was associated with a higher rate of pre-dialysis hypertension than that in those without diabetes, and there was a significant difference in the prevalence of grade III hypertension between the two groups. In conclusion, the mean pre-dialysis SBP among patients undergoing dialysis remained high, and younger patients with diabetes or those receiving anti-hypertensive medications had poor blood pressure control. Optimal blood pressure management may be necessary to reduce the risk of cardiovascular mortality.
高血压在透析患者中患病率较高。我们从日本一个基于网络的全国数据库中提取了 2012 年至 2020 年期间接受透析的患者的数据，记录了其透析前的收缩压（SBP）。根据 2019 年日本高血压学会指南，我们对 SBP 进行了分类，并根据性别、年龄、糖尿病状态和抗高血压药物的使用情况评估了其随时间的变化趋势。使用 2020 年数据库，我们检查了 336759 名接受透析的日本患者（女性 114249 名，男性 222510 名）。患者的平均年龄为 69.4±12.5 岁，平均 SBP 为 152.3±24.7mmHg。透析前高血压的患病率为 70.2%，其中 32.5%、24.5%和 13.2%的患者分别患有 I 级、II 级和 III 级高血压。从 2014 年到 2020 年，在所有年龄组和性别中，患有糖尿病的透析患者的透析前高血压患病率和透析前 SBP 的绝对数值均高于不患有糖尿病的患者。年轻的糖尿病患者或正在服用抗高血压药物的患者的 SBP 约为 160mmHg。与不患有糖尿病的患者相比，患有糖尿病的患者发生脑血管死亡的风险与透析前高血压的患病率较高相关，且两组之间 III 级高血压的患病率存在显著差异。总之，接受透析的患者的透析前 SBP 平均值仍然较高，患有糖尿病的年轻患者或正在服用抗高血压药物的患者血压控制较差。可能需要进行最佳的血压管理以降低心血管死亡率的风险。
