慢性肾脏病患者合并高血压情况及相关因素分析  

The Prevalence and Influencing Factors in Chronic Kidney Disease Patients with Hypertension

作　　者：张婧[1,2] 张爱华[1] 陈邵燕[1] 程李涛[1] 何莲[1] 范敏华[1] 汪涛[1] 

机构地区：[1]北京大学第三医院肾内科,北京100191 [2]北京大学医学部医院

出　　处：《中华高血压杂志》2010年第9期855-860,共6页Chinese Journal of Hypertension

摘　　要：背景高血压促进左心室肥厚,加速慢性肾脏病(CKD)进展,并增加了心血管疾病的风险。国外研究显示高血压在CKD患者中的发生率高而控制率低。我国尚无大样本量的相关数据。目的初步分析我院门诊CKD患者合并高血压的情况及血压控制情况并分析相关因素和治疗情况。方法横断面研究纳入2006-2008年在北医三院肾内科门诊随诊的非透析CKD成年(≥18岁)患者763例。收集入组患者人口学资料、原发病、合并症、血清学化验检查指标、血压控制情况、降压药应用情况等。结果高血压的检出率为70.5%。单纯收缩期高血压(ISH)所占比例逐期上升,从CKD1期的5.1%上升至5期的27.3%(P<0.05);多因素logstic回归分析显示体质量指数(BMI)≥28kg/m2、估算肾小球滤过率(eGFR)<60mL/(min.1.73m2)和糖尿病史为CKD高血压患病的危险因素。高血压的控制率为23.6%(<130/80mmHg为标准)和55.4%(<140/90mmHg)。15.3%的高血压患者未应用任何降压药物治疗,33.8%采用单药治疗方案,34.7%两种药联用,15.6%3种药联用,0.6%4种药联用。血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)使用率最高,为60.7%,其次为钙拮抗剂(50.9%);再次为β受体阻滞剂(28.3%),利尿剂使用率仅4.0%。血压控制差组(血压≥140/90mmHg)24h尿蛋白及总胆固醇高于血压控制好组(P<0.05)。结论 70%以上CKD患者合并高血压,CKD3期以后合并高血压显著升高,ISH是CKD患者最常见的高血压类型。合并高血压的危险因素是肥胖、CKD3～5期和糖尿病史。高血压控制率很低(23.8%)(<130/80mmHg为标准),高血压控制不良可能与尿蛋白较大量及其原发病控制不佳有关。Objective Hypertension promotes left ventricular hypertrophy and the progress of chronic kidney disease （CKD）.It also increases cardiovascular mortality.The prevalence of hypertension in CKD patients is high and the control rate is low.There has been no large sample of CKD with hypertensive study in China so far.This study was to investigate the prevalence of hypertension,its control rate,the use of antihypertensive medications and the influencing factors for hypertension control in CKD patients in our hospital.Methods We analyzed the data of 763 adult CKD patients from our CKD management clinic during 2006-2008.Patient＇s demographic data,underlying kidney diseases,comorbidities,laboratory tests,blood pressure and antihypertensive medications were evaluated.Results The prevalence of hypertension in all CKD patients was 70.5%.The percentage of isolated systolic hypertension （ISH） increased from 5.1% to 27.3% （P0.05）.Multiple regression analysis showed that obesity,stage 3-5 and diabetes were risk factors for hypertension.Blood pressure control rate was only 23.6% （130/80 mm Hg） and 55.4% （140/90 mm Hg）.15.3% of hypertensive patients did not receive anti-hypertensive medication,33.8% was on single therapy,34.7% on two drug combination,15.6% on three drug combination and 0.6% on four drug combination.The angiotensin Ⅱ receptor blockers/angiotensin-converting enzyme inhibitors were the most frequently prescribed drugs （60.7%） followed by calcium antagonist （50.9%）,beta-blockers （23.5%） and diuretics （4%）.The 24-hour urine protein and total cholesterol were higher in uncontrolled blood pressure group than that of controlled one （P0.05）.Conclusion The prevalence of hypertension was 70.5% in all CKD patients.ISH was the most common type of hypertension in CKD patients,which significantly increased with the progressing of renal disease.Even in the CKD management clinic,blood pressure control rate was still low （23.8%）.Poor hypertension control in CKD may be related to prote

关 键 词：慢性肾脏病 高血压 横断面研究 单纯收缩期高血压 

分 类 号：R544.1[医药卫生—心血管疾病]