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Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients.

维持性血液透析患者透析间期血压变异性与卒中风险.

  • 影响因子:1.95
  • DOI:10.1097/MD.0000000000021232
  • 作者列表:"Cheng Y","Li Y","Zhang F","Zhu J","Wang T","Wei M","Mo L","Li Y
  • 发表时间:2020-07-17
Abstract

:Studies on nondialysis populations have linked visit-to-visit blood pressure (BP) variability (BPV) to cerebrovascular events and mortality. In view of the high prevalence of hypertension in hemodialysis patients, the predictive values of numerous factors for stroke, especially visit-to-visit BPV, were evaluated in this prospective cohort study.A total of 151 patients were enrolled in this study. The demographic features and various laboratory parameters were analyzed. At each routine hemodialysis visit, the predialysis, intradialysis, and post-dialysis BP measurements were systematically performed. We defined BPV using 4 metrics: standard deviation of the BP, coefficient of variation, average real variability (ARV), and variability independent of mean (VIM). Differences in the predialysis BPs from one treatment to the next (ie, interdialytic variability) and differences in the BPs from predialysis to post-dialysis (ie, intradialytic variability) were both studied in this work.Twenty-one patients developed stroke and 25 patients died. The multivariate Cox proportional hazards regression model revealed a significant relationship between stroke and the interdialytic BPV (both predialysis systolic BP variability and predialysis diastolic BP variability) and low-density lipoprotein-cholesterol (LDL-C).Our results indicate that a high interdialytic BPV is associated with an increased risk for stroke that is independent of several factors, including age, sex, antihypertensive medication use, and mean BP over time. There is potential that the optimal treatment goal for hemodialysis patients may be to reduce the interdialytic BPV rather than either the mean BP or the intradialytic BPV.

摘要

: 关于非透析人群的研究已将访视间血压 (BP) 变异性 (BPV) 与脑血管事件和死亡率联系起来。鉴于血液透析患者高血压的高患病率,在这项前瞻性队列研究中评估了许多因素对卒中的预测价值,尤其是访视BPV。共有151名患者参加了这项研究。分析了人口统计学特征和各种实验室参数。在每次常规血液透析访视时,系统地进行透析前、透析中和透析后BP测量。我们使用4个指标定义BPV: BP的标准偏差、变异系数、平均真实变异性 (ARV) 和独立于平均值的变异性 (VIM)。在这项工作中,研究了透析前BPs从一种治疗到另一种治疗的差异 (即透析间变异性) 和透析前到透析后BPs的差异 (即透析间变异性)。21名患者发生中风,25名患者死亡。多变量Cox比例风险回归模型揭示了卒中与透析间期BPV (包括透析前收缩压变异性和透析前舒张压变异性) 和低密度脂蛋白胆固醇 (ldl-c) 之间的显著关系。我们的研究结果表明,高透析间期BPV与卒中风险增加相关,这与几个因素无关,包括年龄,性别,抗高血压药物的使用,和平均BP随着时间的推移。血液透析患者的最佳治疗目标可能是降低透析间期BPV,而不是平均BP或透析间期BPV。

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影响因子:1.44
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DOI:10.1111/nep.13588
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