上海市维持性血液透析患者高血压现状的多中心调查

A multi-center survey of hypertension and its treatment in patients with maintenance hemodialysis in Shanghai

目的 了解维持性血液透析（血透）患者高血压的患病和治疗情况,为血透患者的高血压诊断和治疗提供依据.方法 对上海市11家透析中心的1382例维持性血透患者进行横断面调查,其中男性809例,女性573例.结果 （1）本次受访的维持性血透患者高血压患病率为86.3%,治疗率96.8%,控制率[血透前血压＜140/90 mm Hg（1 mm Hg=0.133 kPa）]25.5%;（2）50.4%患者应用一种降压药,应用2、3和4种或以上者占34.4%、14.2%和1.0%.单药用药以钙通道阻滞剂为多（61.0%）,血管紧张素Ⅱ受体拮抗剂和血管紧张素转换酶抑制剂分别为56.4%和6.4%,中枢性降压药物为26.4%,β或α、β阻滞剂为14.0%.联合用药以钙通道阻滞剂联合血管紧张素Ⅱ受体拮抗剂最常用（63.2%）;（3）冠心病、透析充分性和用药数量影响血透患者的高血压控制率,冠心病以及联合用药者高血压控制更困难,而充分透析有助于提高高血压控制率.结论 维持性血透患者中高血压极为常见,患病率和治疗率均较高,但控制率很低,降压药物的联合应用不够.维持性血透患者的血压控制情况受透析充分性、心脏疾病、降压药物使用情况等多种因素影响.

Objective To study the prevalence,treatment policy and control of hypertension in patients with maintenance hemodialysis, and to analyze the influencing factors of hypertension control.Methods We studied the current status of 1382 patients with maintenance hemodialysis in 11 dialysis centers in Shanghai, among them 809 were male, and 573 were female.Hypertension was defined as systolic blood pressure（SBP） ≥ 140 and/or diastolic blood pressure （DBP） ≥90 mm Hg （ 1 mm Hg = 0.133 kPa）.Those who had a history of hypertension and requiring antihypertensive therapy were also diagnosed as hypertension though their blood pressure was within normal range during the survey.Hypertension control was defined as blood pressure 〈 140/90 mm Hg before each dialysis session.Results The prevalence of hypertension in the hemodialysis patients was 86.3%.The treatment rate and control rate in those patients were 96.8% and 25.5% respectively.More than half （50.4% ） of patients were treated with only one kind of anti-hypertensive drug, and 34.4% with 2 kinds, 14.2% with 3 kinds, 1.0% with 4 kinds or more.Calcium channel blocker （CCB） was the most frequently prescribed drug （61.0%）, followed by angiotensin Ⅱ receptor blockers （ 56.4% ）, centrally acting anti-hypertensive agent （ 26.4% ）, beta blockers and alpha, beta-blockers（ 14.0% ）.The control rate of hypertension in those hemodialysis people was aggravated by the existence of coronary artery disease.The patients who need more kinds of antihypertensive agents have a poorer control rate of hypertension.The hypertension control rate elevated significantly with the adequate hemodialysis.Conclusions There is a very high prevalence of hypertension in maintenance hemodialysis patients.Although the treatment rate is high, the control rate is unsatisfactory.So the control of hypertension in hemodialysis patient is still a clinical challenge.Appropriate dialysis adequacy, reasonable use of erythropoietin, treatment of heart disease and judicious use of antihypertensive drugs may be helpful to improve the clinical outcome.