慢性肾脏病非透析患者治疗性高血压抵抗患病率的Meta分析

Prevalence of apparent treatment resistant hypertension in non-dialysis patients with chronic kidney disease:a meta-analysis

目的系统评价慢性肾脏病(chronic kidney disease,CKD)非透析患者治疗性高血压抵抗(apparent treatment resistant hypertension,aTRH)的患病率。方法检索中英文数据库中有关CKD非透析患者aTRH患病率的观察性研究,aTRH定义为参考美国心脏协会(American Heart Association,AHA)所提出的AHA-1及AHA-2,应用Stata15.0软件对不同aTRH定义下的CKD总体和分期的患病率进行荟萃(Meta)分析。结果共纳入14项研究,CKD患者aTRH的总患病率27.1%(ES=0.271,95%CI:0.220~0.321,P<0.001);AHA-1定义下,CKD 1~5期患者中aTRH患病率为20.6%(ES=0.206,95%CI:0.105~0.307,P<0.001),CKD 3~5期患者中aTRH的患病率为29.5%(ES=0.295,95%CI:0.224~0.366,P<0.001);AHA-2定义下,CKD 1~5期患者的aTRH患病率为30.4%(ES=0.304,95%CI:0.178~0.430,P<0.001);CKD的aTRH患病率均呈现出随着肾小球滤过率的下降而不断升高的趋势。结论CKD非透析患者aTRH患病率较高,并随肾损伤的进展逐步上升,应加强对慢性肾脏病患者aTRH的关注。

Objective To systematically review the prevalence of apparent treatment resistant hypertension(aTRH)in non-dialysis patients with chronic kidney disease(CKD).Methods Chinese and English databases were searched for observational studies on the prevalence of aTRH in non-dialysis patients with CKD.According to the American Heart Association(AHA)criteria,aTRH was defined as AHA-1 and AHA-2.Stata 15.0 was used for the meta-analysis of overall and staged prevalence of CKD under different aTRH definitions.Results A total of 14 studies were included.The overall prevalence of aTRH in CKD patients was 27.1%(ES=0.271,95%CI:0.220~0.321,P<0.001).Under AHA-1 definition,the prevalence of aTRH in CKD1-5 patients was 20.6%(ES=0.206,95%CI:0.105~0.307,P<0.001),and the prevalence of aTRH in CKD3-5 patients was 29.5%(ES=0.295,95%CI:0.224~0.366,P<0.001).Under AHA-2 definition,the prevalence of aTRH in CKD1-5 patients was 30.4%(ES=0.304,95%CI:0.178~0.430,P<0.001).The prevalence of aTRH in CKD patients increased with the decrease of glomerular filtration rate in all original studies.Conclusion The prevalence of aTRH in non-dialysis CKD patients is high and increases with the progression of renal injury.More attention should be paid to aTRH in CKD patients.