在患有晚期CKD的患者中,家庭强化降低血压
Elaine Ku1, Timothy P Copeland2, Charles E McCulloch3
1Division of Nephrology, Department of Medicine, University of California-San Francisco, San Francisco, California; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California.
概括
密集的血压 (BP) 控制到静脉压目标低于120mmHg是可以实现的,并且对于晚期慢性病 (CKD) 患者来说似乎是安全的. 在本试点研究中,家庭BP监测促进了这种密集的BP管理,没有显著的不良事件.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 高血压管理 高血压管理
背景情况:
- 在晚期慢性病 (CKD) 中,最佳血压 (BP) 目标仍然存在争议.
- 在晚期慢性病中强化降低血压可能会增加急性损伤,高血和末期病的风险.
研究的目的:
- 为了确定在晚期CKD患者中是否可以安全地实现较低的家庭静脉压 (SBP) 目标 (<120 mm Hg).
- 评估使用家庭血压监测和药物定位进行密集血压控制的可行性.
主要方法:
- 一项非盲目的随机对照试验,涉及108名患有晚期CKD (eGFR≤30 mL/min/1.73 m2) 和高血压的患者.
- 参与者被随机分配到一个密集的SBP目标 (<120毫米升) 或一个不那么密集的目标.
- 家庭血压被无线监测,实时向提供者传输数据以进行药物定位.
主要成果:
- 强化SBP组在4-12个月内获得了平均临床SBP11.7 mm Hg低于不那么强化SBP组 (P<0.001).
- 在第12个月的临床SBP平均值是124.7 mm Hg在密集型组,而138.2 mm Hg在不那么密集的组.
- 两组之间在初级安全结果 (高卡血,跌倒,昏迷,需要透析/移植) 中没有观察到统计学上显著的差异.
结论:
- 临床SBP目标<120 mm Hg是可行的,并且在使用实时家庭血压监测的晚期CKD患者中似乎是安全的.
- 需要进行更大规模的试验来确认最佳的血压目标以及密集控制血压的风险/益处.
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