急性心肌梗死合并慢性肾脏病患者血压变化趋势

Trends of blood pressure in patients with acute myocardial infarction combined with chronic kidney disease

目的急性心肌梗死(AMI)合并慢性肾脏病(CKD)患者血压随CKD分期的变化趋势。方法连续收集同一中心AMI合并CKD3期、CKD4期和CKD5期的所有患者(n=324)。根据标准法测量的收缩压和舒张压将这些患者分为四个血压类型:正常血压(SBP/DBP<140/90 mm Hg)、孤立收缩期高血压(ISH,SBP≥140 mm Hg, DBP<90 mm Hg)、孤立舒张期高血压(IDH, SBP<140 mm Hg, DBP≥90 mm Hg)和双期高血压(SDH, SBP/DBP≥140/90 mm Hg)。结果总体血压控制率为45.7%,而且随着CKD分期逐级降低。孤立舒张期高血压在CKD3期、CKD4期及CKD5期中发生率分别为5.0%、5.3%和0,双期高血压在CKD3期、CKD4期及CKD5期中发生率并没有显著变化(分别为15.0%、14.9%和15.7%),孤立收缩期高血压发生率随着CKD分期逐级升高(分别为28.1%、39.4%和45.7%)。逻辑回归分析发现,年龄和CKD分期是这些患者孤立收缩期高血压的独立危险因素(CKD5期患者发生孤立收缩期高血压的风险分别是CKD3期和CKD4期的2.13倍和3.99倍)。结论 AMI合并CKD患者孤立收缩期高血压发生率随着CKD分期逐级升高,而且CKD分期是孤立收缩期高血压发生率升高的危险因素,这也是CKD发展过程中导致心血管事件病死率升高的一部分原因。

Objective To investigate the trends of blood pressure in patients with acute myocardial infarction ( AMI) combined with chronic kidney disease ( CKD). Methods AMI combined with CKD patients of stage 3 , 4 and 5 were consecutively recruited from a single center ( n = 324 )· Based on office measured systolic blood pressure (SBP) and diastolic blood pressure ( DBP), they were classified into any of the four hypertensive subtypes: normotension ( SBP/DBP < 140/90 mm Hg), isolated diastolic hypertension (IDH, SBP < 140 mm Hg, DBP≥90 mm Hg), ISH (SBP≥140 mm Hg, DBP <90 mm Hg) and systolic - diastolic hypertension (SDH, SBP/DBP≥ 140/90 mm Hg). Results The overall control rate of hypertension was 45. 7%, with decreased control rate relative to advanced CKD stages. The prevalence of IDH changed from 5.0% to 5. 3% and 0 from stage 3 to 4 and 5 , while no significant change in the prevalence of SDH was observed (15.0%, 14. 9% and 15.7% in stage 3 , 4 and 5 , respectively). There was a stepwise increase in the prevalence of ISH with the stages of CKD (it was 28. 1 %, 39. 4% and 45. 7% in stage 3 , 4 and 5 , respectively). Logistic regression analysis showed that age and CKD stages ( compared with stage 3 , stage 4 and 5 had 2. 13 and 3. 99 folds higher risk to develop ISH , respectively) were independent predictors of ISH in these patients. Conclusion The prevalence of ISH increases correspondingly with the advanced stages of CKD, and more advanced CKD stage are associated with increased risk to develop ISH , which may partially contribute to increased cardiovascular mortality during the progress of CKD.