在接受维护血液透析的患者中,脉压与死亡率之间的关联
Preston S Klassen1, Edmund G Lowrie, Donal N Reddan
1Duke Institute of Renal Outcomes Research and Health Policy, Box 3646, Duke University Medical Center, Durham, NC 27710. klass001@mc.duke.edu
JAMA
|March 26, 2002
概括
在接受维护血液透析的患者中,高脉压与死亡风险增加有关. 这与典型的血压检测结果形成鲜明对比,强调脉冲压力.
科学领域:
- 脏病学和心血管医学.
- 流行病学和公共卫生.
背景情况:
- 血压升高通常表明一般人群的不良结果.
- 然而,在接受维持血液透析的末期病 (ESRD) 患者中,血压升高与死亡率降低有悖论的联系.
- 脉压,反映了心脏周期的脉动性质,已成为一般人群中显著的预测因素.
研究的目的:
- 研究在接受维护血液透析的患者中脉压和死亡率之间的关联.
- 测试该假设,即增加脉压与在一年内死亡的风险更高相关,尽管在ESRD患者中观察到与常规血压测量的反向关系.
主要方法:
- 一项回顾性队列研究包括来自782个美国血液透析设施的37,069名患者.
- 数据收集时间为1997年10月至12月,追踪时间为1998年12月.
- 主要结局是1年内全因死亡率.
主要成果:
- 透析后脉压增加10mmHg与12%的死亡风险增加有关 (HR,1.12;95%CI,1.06-1.18),在调整了静脉血压后.
- 相反,透析后静脉血压增加10 mm Hg与死亡风险降低13%有关 (HR,0.87;95% CI,0.84-0.90).
- 与高脉压相关的因素包括年龄,糖尿病,白人,女性性别和透析时间较长.
结论:
- 脉压是维护血液透析患者的大型,全国代表性样本中死亡率的重要预测因素.
- 这些发现强调了在风险分层中考虑脉冲压的重要性,并建议进一步研究ESRD血管功能的治疗影响.
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