Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients
Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients
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DOI：
10.1016/s0272-6386(99)70187-3
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发表时间：
1999-03-01
影响因子：
13.2
通讯作者：
Smith, MC
中科院分区：
文献类型：
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作者：
Rahman, M;Dixit, A;Smith, MC
高血压在血液透析患者中很常见，可增加心血管疾病的发病率和死亡率。我们确定了489例接受血液透析的患者中高血压控制不佳的患病率，并确定了与高血压控制不佳相关的因素。我们对患者进行了访谈，并从计算机数据库中提取了人口统计学和临床信息，（平均透析前血压，大于或等于160/90 mm Hg）为62%，91%的高血压不受控制的患者正在接受次最大抗高血压药物治疗，59%的患者在透析前暂停药物治疗，未控制的高血压患者透析间期体重增加更大（3.8%对3.5%，P = 0.07）结束更大的额外体重增加（3.1 +/- 1.6公斤对2.5 +/- 1.4公斤; P < 0.05）与对照组比较，高血压未控制的患者透析间期体重增加更高（2.7 +/- 0.06 kg vs2.2 +/- 0.13 kg; P < 0.05），更可能是黑人（94%vs81%，P < 0.05），高血压是终末期肾病（ESRD）的主要病因（42% vs24%; P < 0.05），接受血液透析的时间较短（4.3 +/- 2年vs6.1 +/- 0.9年; P < 0.05）。高血压患者舒张压与透析间期体重增加（r = 0.31，P < 0.05）和体重增加百分比（r = 0.34，P < 0.05）呈显著相关，而正常血压患者舒张压与透析间期体重增加（r = -0.21）无相关性。我们的结论是，高血压是不受控制的，在大多数患者接受血液透析。次最大抗高血压治疗、透析间期体重过度增加和透析前停用抗高血压药物是可能导致高血压不受控制的可纠正因素。
Hypertension is common in hemodialysis patients and increases cardiovascular morbidity and mortality. We determined the prevalence of inadequate control of hypertension in 489 patients receiving hemodialysis and identified factors associated with uncontrolled hypertension. We interviewed the patients and abstracted demographic and clinical information from a computerized database, The prevalence of uncontrolled hypertension (average predialysis blood pressure, greater than or equal to 160/90 mm Hg) was 62%, Ninety-one percent of patients with uncontrolled hypertension were receiving submaximal antihypertensive drug therapy, and 59% withheld their medications before dialysis, Uncontrolled hypertensives had a greater interdialytic weight gain (3.8% v 3.5%, P = 0.07) end a greater excess weight gain (3.1 +/- 1.6 kg v 2.5 +/- 1.4 kg; P < 0.05) compared with controlled hypertensives, Patients with uncontrolled hypertension showed higher interdialytic weight gain (2.7 +/- 0.06 kg v 2.2 +/- 0.13 kg; P < 0.05), were more likely to be black (94% v 81%; P < 0.05), were more likely to have hypertension as the cause of their end stage renal disease (ESRD) (42% v 24%; P < 0.05), and had been receiving hemodialysis for a shorter time (4.3 +/- 2 yr v 6.1 +/- 0.9 yr; P < 0.05) compared with normotensive patients. There was significant correlation between diastolic blood pressure and both interdialytic weight gain (r = 0.31, P < 0.05) and percent weight gain (r = 0.34, P < 0.05) in the hypertensive but not in the normotensive patients (r = -0.21), Interdialytic weight gain and hypertension as a cause of ESRD were independent predictors of predialysis systolic blood pressure. We conclude that hypertension is uncontrolled in most patients undergoing hemodialysis. Submaximal antihypertensive therapy, excessive interdialytic weight gain, and withholding antihypertensive medication before dialysis are correctable factors potentially contributing to uncontrolled hypertension.