降压药用药方案评估伴高血压的慢性肾脏病患者

Assessment patterns of anti-hypertensive agents among chronic kidney disease patients with hypertension

目的评估伴高血压的慢性肾脏病(CKD)患者应用降血压药的临床治疗方案和血压达标率。方法本研究为回顾性横断面研究。对204例成年慢性肾脏病患者在肾病专科门诊至少随访6个月后,于观察期内以末次就诊时的血压达标率和用药方案与其在首诊时血压控制情况和用药方案加以比较。结果末次就诊时,超过70%的患者使用了血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体Ⅱ受体拮抗剂(ARB),其次是钙通道阻滞剂(CCB)(51.96%)和利尿药(19.12%)。单药治疗方案中最常用的降血压药是ACEI或ARB,近50%的患者接受2药或3药联合治疗。治疗结果显示,只有31.86%的CKD患者血压达标(<130/80mmHg),收缩压(SBP)比舒张压(DBP)更难控制。单药和多药治疗的CKD患者血压达标率分别是39.64%和22.58%,(P<0.01),结论大多数的CKD患者血压未达标,所应用降血压药的临床治疗方案基本符合高血压治疗指南。需要继续优化治疗方案,正确联合用药,提高CKD患者的血压控制率。临床药师在协助医师,共同控制CKD患者血压方面将大有可为。

Objective To evaluate utilization patterns of anti-hypertensive agents and Blood Pressure（BP） control among chronic kidney disease （CKD） patients with hypertension. Methods Retrospective cross-sectional study. BP control rates, proportions of use of different anti-hypertensive drug classes and treatment regimen were compared between the first time visit and the last time visit during the study periods in 204 adult non-dialyzed CKI） patients followed up by a nephrologist for at least 6 months. Results At the last visit, over 70% of patients were receiving angiotensin-converting enzyme inhibitors （ACEI） or angiotensin receptor blocker （ARB）, followed by calcium channel blockers（51.96%） and diuretics（19.12%）, ACEI/ARB was the most frequently used on monotherapy. Nearly half of the patients were on combination treatment. BP target （〈130/80mmHg） was only achieved in 31.86% of patients. Systolic target was less frequently reached than the diastolic target. The proportions of patients on monotherapy or on combination therapy achieving BP control were 39.64% and 22.58%,respectively （P〈0.01）. Conclusions BP target was not reached in most CKD patients routinely seen in the renal clinics. Patterns of anti-hypertensive therapy were generally consistent with evidence-based practice guidelines. It was very hopeful for clinic pharmacists to cooperate with doctors in management of hypertension.