慢性肾脏病患者高血压现状的横断面调查

Cross-sectional study on hypertension in patients with chronic kidney disease

目的对慢性肾脏病（CKD）患者高血压的发病和治疗情况进行横断面调查。方法调查对象为2006年11月至2007年3月本院。肾内科门诊就诊的900例CKD患者，男性480例，女性420例，其中维持性透析患者354例（血透228例，腹透126例）。结果（1）本组CKD患者高血压患病率为80．2％，其中男性患病率高于女性患者（83．5％比76．4％，P〈0．01）；维持性透析患者显著高于非透析患者（90．1％比73．8％，P〈0．01）；血液透析与腹膜透析患者的高血压患病率分别为91．7％和87．3％，差异无统计学意义。（2）高血压治疗率为92．4％，透析患者显著高于非透析患者（95．6％比89．8％，P〈0．01）。（3）非透析患者高血压控制率（〈130／80mmHg为标准）为20．4％．而尿蛋自量（24h）〉1g的未透析患者，其血压控制在125／75mmHg以下者仅占8．4％。透析患者高血压控制率（〈140／90mmHg）显著低于非透析患者（45．2％比55．5％，P〈0．01），其中血液透析组高血压控制率显著高于腹膜透析组（49．8％比36．5％，P〈0．05）。（4）CKD患者高血压患病率随肾功能减退和年龄增长逐渐增高；糖尿病肾病患者的高血压患病率高于原发性肾小球疾病患者。高龄、糖尿病、肥胖、肾功能减退、高脂血症均为CKD高血压发病的危险因素。（5）CKD患者服用1、2、3和4种降压药物及以上者分别为37．2％、37．5％、19．3％和5．9％。单药用药以钙通道阻滞剂（CCB）最多（74．1％），血管紧张素受体阻滞剂（ARB）和血管紧张素转换酶抑制剂（ACEI）分别为48．4％和25．6％，d、B受体阻滞剂为24．7％。联合用药以CCB联合ACEI或ARB最常用。结论CKD患者中高血压患病率很高。年龄、肾功能减退、糖尿病、肥胖是CKD高血压的危险因素。CKD患者高血压的治疗率较高，但控制率较低，透析患者和尿蛋白量较多患者的高血压控制情况更是有待提高。

Objective To investigate the situation of prevalence, treatment and control of hypertension in patients with chrnnic kidney disease （CKD） by cross-sectional study. Methods Nine hundred out-patients with CKD in our department from November 2006 to March 2007 were enrolled in the study, including 480 male and 420 female. Among 900 CKD cases, 354 patients underwent maintenance dialysis, including 228 on hemodialysis and 126 on peritoneal dialysis. Results The prevalence of hypertension in CKD patients was 80.2% （male 83.5% vs female 76.4%, P〈0.01 ）. The prevalence of hypertension in patients on dialysis was significantly higher than that in non-dialysis patients （90.1% vs 73.8%, P〈0.01）, but there was no significant difference between hemodiatysis and peritoneal dialysis cases. Antihypertensive treatment rate was 92.4% in CKD patients with hypertension, and was significantly higher in patients on dialysis than that in non-dialysis patients （95.6% vs 89.8%, P〈0.01 ）. The control rate according to current recommendations for CKD patients （BP〈130/80 mm Hg） was very low. Control of both SBP and DBP was only achieved in 20.4% of non- dialysis patients. The control rate of hypertension （BP〈 125/75 mm Hg） in patients with proteinuria 〉1 g/24 h was 8.4%. The proportion of dialysis patients with BP〈140/90 mm Hg was significantly lower than that of non-dialysis patients （45.2% vs 55.5%, P〈0.01）. The percentage of hemodialysis patients with BP〈140/90 mm Hg was significantly higher than that of peritoneal dialysis patients （49.8% vs 36.5%, P〈0.05）. The prevalence of hypertension was associated with the decrease of renal function and the increase of age. The prevalence of hypertension in diabetic nephropathy was higher than that in primary glomerular diseases. Patients received 1, 2, 3 and 4 or more kinds of antihypertensive drugs accounted for 37.2%, 37.5%, 19.3% and 5.9% respectively. The combination of calcium channel blocker （CCB） and renin-angiotensin-aldosterone system （RAAS） inhibitors was more frequently used in CKD patients. The CCB was the most frequently prescribed drug （74.1%）, followed by angiotensin Ⅱ receptor blockers （ARB） （48.4%）, angiotensin-eonverting enzyme inhibitors （ACEI） （25.6%） and alpha, beta-blockers （24.7%）. Conclusions The prevalence of hypertension in CKD patients is quite high, which is associated with the progression of renal function, increase of age, the type of underlying kidney disease, obesity and diabetes mellitus. The control of hypertension is unsatisfied in CKD patients, especially in dialysis patients and those with overt proteinuria.