Hypertension:慢性肾病患者难治性高血压的发生率较高,预后不好

2016-01-04 phylis 译 MedSci原创

慢性肾脏病患者中难治性高血压(ATRH)和临床结果的关系尚未研究清楚。研究者分析慢性肾功能不全队列研究(CRIC)中3367名高血压患者的数据,确定非透析慢性肾病患者ATRH的发生率,相关性及临床预后。ATRH的定义为应用三种及三种以上的抗高血压药血压≥140/90mmHg,或者基线时,应用四种及四种以上的抗高血压的药,才能维持血压在目标值。ATRH的发生率为40.4%。高龄,男性,黑人,糖尿病,

慢性肾脏病患者中难治性高血压(ATRH)和临床结果的关系尚未研究清楚。研究者分析慢性肾功能不全队列研究(CRIC)中3367名高血压患者的数据,确定非透析慢性肾病患者ATRH的发生率、相关性及临床预后。

ATRH的定义为应用三种及三种以上的抗高血压药,且血压≥140/90mmHg,或者基线时,应用四种及四种以上的抗高血压药,才能维持血压在目标值。ATRH的发生率为40.4%。高龄、男性、黑人、糖尿病、BMI较高与ATRH发生较高相关。ATRH受试者比非ATRH患者的临床事件发生率较高,比如心肌梗死、卒中、外周动脉疾病、充血性心力衰竭(CHF)以及各种原因的死亡的复合预后(HR(95%CI))(1.38 [ 1.22-1.56 ]),肾脏事件(1.28 [ 1.11-1.46 ]);心力衰竭(1.66 [ 1.38-2.00 ]);与全因死亡率(1.24 [ 1.06-1.45 ])。各种类型的ATRH及应用4种抗血压药物维持血压在目标值的受试者,心急梗死,卒中,外周动脉疾病,CHF及全因死亡率等复合预后的发生率增加(HR(95%CI))(1.30 [ 1.12-1.51 ]),和CHF(1.59 [ 1.28-1.99 ])发生高于非ATRH患者。在那些肾小球滤过率≥30mL/min/1.73m2的受试者,ATRH与CHF和肾脏事件的发生相关。

研究结果表明慢性肾脏病患者中难治性高血压是常见的,并与慢性肾脏病患者不良预后的高风险相关。这表明需要早期识别和管理慢性肾脏疾病发生ATRH患者。

原文出处:

Thomas G, Xie D, et al. Prevalence and Prognostic Significance of Apparent Treatment Resistant Hypertension in Chronic Kidney Disease: Report From the Chronic Renal Insufficiency Cohort Study. Hypertension. 2015 Dec 28.

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    2016-07-26 feather89
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    2016-01-06 freve

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