Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis
Association between pulse pressure and mortality in patients undergoing maintenance hemodialysis
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DOI：
10.1001/jama.287.12.1548
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发表时间：
2002-03-27
影响因子：
120.7
通讯作者：
Owen, WF
中科院分区：
文献类型：
--
作者：
Klassen, PS;Lowrie, EG;Owen, WF
尽管血压升高与一般人群的不良后果相关，但血压升高与接受维持性血液透析的终末期肾病患者死亡率降低相关。最近对普通人群的研究证明了脉压（收缩压减去舒张压）的预测效用，脉压是反映心动周期搏动性质的指标。目的 评估接受维持性血液透析患者的脉压与死亡率之间的关系，并检验我们的假设，即尽管传统血压测量与终末期肾病患者的死亡率之间存在反比关系，但脉压增加与长达 1 年的死亡风险增加相关。设计、设置和患者回顾对在美国 782 个血液透析机构接受维持性血液透析的终末期肾病患者进行的队列研究。截至1998年1月1日，共有44069名符合条件的患者，其中37069名具有完整人口统计数据的患者被纳入对1997年10月1日至12月31日收集的临床和实验室数据的分析中。患者随访至1998年12月31日。 主要结果指标主要研究结果是第1年的死亡。次要结果是脉压的大小。 结果 最终患者队列在年龄、性别、种族和糖尿病状况方面与全国平均水平相似。透析前平均（SD）脉压为75.0（15.0）mm Hg，透析后为66.9（13.9）mm Hg。到1年随访结束时，5731名患者（18.4%）死亡。调整收缩压水平后，多变量 Cox 比例风险模型显示脉压增加与死亡风险增加之间存在直接且一致的关系。透析后脉压每升高 10 mm Hg，死亡风险就会增加 12%（风险比，1.12；95% 置信区间，1.06-1.18）。透析后收缩压与死亡率呈负相关，每升高 10 mm Hg，死亡风险就会降低 13%（风险比，0.87；95% 置信区间，0.84-0.90）。在多变量线性回归模型中，与脉压升高直接相关的重要变量包括年龄、糖尿病、白种人、女性和接受透析的年数（所有 P
Context Although increased blood pressure is associated with adverse outcomes in the general population, elevated blood pressure is associated with decreased mortality in patients with end-stage renal disease undergoing maintenance hemodialysis. Recent investigations in the general population have demonstrated the predictive utility of pulse pressure (systolic minus diastolic blood pressure), a measure reflecting the pulsatile nature of the cardiac cycle.Objectives To estimate the relationship between pulse pressure and mortality in patients undergoing maintenance hemodialysis and to test our hypothesis that an increasing pulse pressure would be associated with increased risk of death up to 1 year despite the inverse relationship between conventional blood pressure measures and mortality in patients with end-stage renal disease.Design, Setting, and Patients Retrospective cohort investigation of patients with end-stage renal disease undergoing maintenance hemodialysis at 782 hemodialysis facilities throughout the United States. Of 44 069 eligible patients as of January 1, 1998, 37069 with complete demographic data were included in the analyses of clinical and laboratory data collected from October I through December 31, 1997. Patients were followed up through December 31, 1998.Main Outcome Measures The primary study outcome was death at I year. A secondary outcome was the magnitude of the pulse pressure.Results The final patient cohort was similar to national averages with respect to age, sex, race, and diabetic status. Mean (SD) pulse pressures before dialysis were 75.0 (15.0) mm Hg and 66.9 (13.9) mm Hg after dialysis, By the end of the 1-year follow-up, 5731 patients (18.4%) died. After adjusting for level of systolic blood pressure, multivariable Cox proportional hazards modeling showed a direct and consistent relationship between increasing pulse pressure and increasing death risk. Each incremental elevation of 10 mm Hg in postdialysis pulse pressure was associated with a 12% increase in the hazard for death (hazard ratio, 1.12; 95% confidence interval, 1.06-1.18). Postdialysis systolic blood pressure was inversely related to mortality with a 13% decreased hazard for death for each incremental elevation of 10 mm Hg (hazard ratio, 0.87; 95% confidence interval, 0.84-0.90). In a multivariable linear regression model, important variables directly associated with elevated pulse pressure included age, diabetes, white race, female sex, and number of years receiving dialysis (all P