抗高血压药物治疗与血液透析中低血压风险

Antihypertensive Drug Treatment and the Risk for Intrahemodialysis Hypotension.

作者信息

Zoccali Carmine, Tripepi Giovanni, Carioni Paola, Fu Edouard L, Dekker Friedo, Stel Vianda, Jager Kitty J, Mallamaci Francesca, Hymes Jeffrey L, Maddux Franklin W, Stuard Stefano

机构信息

Renal Research Institute, New York, New York.

Institute of Molecular Biology and Genetics (Biogem), Ariano Irpino, Italy.

出版信息

Clin J Am Soc Nephrol. 2024 Oct 1;19(10):1310-1318. doi: 10.2215/CJN.0000000000000521. Epub 2024 Jul 16.

DOI:10.2215/CJN.0000000000000521

PMID:39012707

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11469783/

Abstract

KEY POINTS

Antihypertensive medications are often used by hemodialysis patients, and intradialytic hypotension is a common complication in these patients. The study emulates a randomized clinical trial comparing antihypertensive drug treatment for the risk of hemodialysis hypotension in 4072 incident patients. Compared with calcium antagonists, and – blockers, angiotensin converting enzyme inhibitors or angiotensin II antagonists, and diuretics may increase the risk of hemodialysis hypotension.

BACKGROUND

Antihypertensive medications are often prescribed to manage hypertension in hemodialysis patients, and intradialytic hypotension (IDH) is a common complication in these patients. We investigated the risk of IDH in incident hemodialysis patients who initiated treatment with antihypertensive drugs in monotherapy.

METHODS

The study was conducted as an emulation of a randomized clinical trial in 4072 incident hemodialysis patients who started antihypertensive drug treatment between January 2016 and December 2019. The primary outcome was the occurrence of IDH during hemodialysis sessions. The generalized estimating equation analysis was adjusted by inverse probability treatment weighting.

RESULTS

Calcium channel blocker (CCB) use was associated with an IDH incidence rate of 7.4 events per person-year (95% confidence interval [CI], 6.2 to 8.6). Compared with CCB use, use of and – blockers was strongly associated with a higher likelihood of IDH (odds ratio [OR] [95% CI, 2.27; 1.50 to 3.43]). The use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (OR [95% CI, 1.71; 1.14 to 2.57]) and diuretics (OR [95% CI, 1.52; 1.07 to 2.16]) were also associated with a higher likelihood of IDH compared with CCB use.

CONCLUSIONS

The study suggests that using and – blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and diuretics may increase the risk of IDH in hemodialysis patients compared with CCB use.

摘要

要点

血液透析患者常使用抗高血压药物，透析中低血压是这些患者的常见并发症。该研究模拟了一项随机临床试验，比较了4072例初治患者使用抗高血压药物治疗发生血液透析低血压的风险。与钙拮抗剂、β受体阻滞剂相比，血管紧张素转换酶抑制剂或血管紧张素II拮抗剂以及利尿剂可能会增加血液透析低血压的风险。

背景

血液透析患者常被处方抗高血压药物来控制高血压，透析中低血压（IDH）是这些患者的常见并发症。我们调查了开始单药抗高血压药物治疗的初治血液透析患者发生IDH的风险。

方法

该研究模拟了一项随机临床试验，纳入了2016年1月至2019年12月开始抗高血压药物治疗的4072例初治血液透析患者。主要结局是血液透析期间IDH的发生情况。采用逆概率处理加权法进行广义估计方程分析。

结果

使用钙通道阻滞剂（CCB）时，IDH发病率为每人年7.4次事件（95%置信区间[CI]，6.2至8.6）。与使用CCB相比，使用β受体阻滞剂与IDH发生的可能性更高密切相关（比值比[OR][95%CI，2.27；1.50至3.43]）。与使用CCB相比，使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂（OR[95%CI，1.71；1.14至2.57]）和利尿剂（OR[95%CI，1.52；1.07至2.16]）也与IDH发生的可能性更高相关。