维持性血液透析患者高血压的控制及其相关因素分析

目的回顾分析北京大学人民医院肾内科血液透析中心维持性血液透析（MHD）患者高血压控制情况及血压控制不佳的相关因素,探讨高血压治疗的合理对策。方法分析MHD高血压患者高血压的特点及血压未控制的可能原因,观察采取个体化治疗措施6个月后血压控制情况。结果MHD患者高血压的患病率为85.2%。高血压以单纯收缩压升高为主（52.2%）,仅2.1%患者为单纯舒张压升高,另有22.8%表现为收缩压和舒张压均升高。Logistic回归分析表明透析间期体重增加量（β=1.932,P=0.012）、体重增加率（β=9.85,P=0.030）、透析不充分（β=-3.448、P=0.008）及血清iPTH水平（β=0.005、P=0.002）是影响透析前收缩压的独立危险因素。采取个体化治疗措施6个月后,透析间期体重增长量[（2.90±0.92）kg比（3.43±1.15）kg]及体重增加率[（4.17±1.59）%比（4.75±1.90）%均降低（P〈0.05）]。血压达标率提高（57.4%比22.8%,P〈0.01）,降压药物剂量（3.55±1.31）比（3.00±1.26）DDD减少。结论透析间期体重增长过多、透析不充分、高血清甲状旁腺激素水平是透析前收缩压的独立危险因素。控制透析间期体重增长、减少容量负荷是治疗MHD患者高血压的基本措施。

Control Of hypertension and factors relating to hypertension in maintenance hemodialysis patients

Objective To evaluate the prevalence of hypertension in maintenance hemodialysis （MHD） patients, and to analyze the clinical and biochemical variables relating to hypertension. Methods We retrospectively analyzed the characteristics of hypertension and tried to find out the causes leading to unsatisfactory control of hypertension in 108 MHD patients in authors＇ hospital. We observed their blood pressure change after individualized anti-hypertension therapy for 6 months. We also monitored their clinical and biochemical variables, blood pressure and body weight after each dialysis session for 2 weeks. Results The prevalence of hypertension was 85. 2% in this cohort of patients, of which 52.2% were systolic hypertension, 2.1% were diastolic hypertension, and 22. 8% were systolic and diastolic hypertension. Logistic regression analyses indicated that the independent risk factors for systolic hypertension before dialysis were intradialysis weight gain （β=1.932, P=0.012）, percentage of body weight gain （B=9.85, P=-0.030）, serum iPTH （β=0.005, P=0.002）, and inadequate dialysis （β= -3.448, P=0.008）. After the individualized therapy for 6 months, blood pressure returned to satisfactory level in 57.4% patients; intradialysis weight gain （2.90±0.92kg vs. 3.43±1.15kg）, percentage of body weight gain （4.17±1.59% vs. 4.75±1.90%）, and the daily dose of anti-hypertension drugs （3.55±1.31 vs 3.00±1.26） decreased significantly （P〈0.05）. Conclusion The independent risk factors for hypertension before dialysis in MHD patients were higher intradialysis body weight gain, inadequate dialysis, and increased serum parathyroid hormone. Therefore, the essential measures for hypertension control in MHD patients are reduction of intradialysis body weight gain and prevention of volume overload.