慢性肾脏病患者高血压的控制及其相关因素  

Control of hypertension in patients with chronic kidney disease and its associated factors

作　　者：金晓红[1] 王莹[1] 范伟峰[1] 张琦[1] 罗丽红[1] 钱英俊[1] 李鹏[1] 张丽红[1] 牛建英[1] 顾勇[1,2] 

机构地区：[1]复旦大学附属上海市第五人民医院肾内科,200240 [2]复旦大学附属华山医院肾内科

出　　处：《中华肾脏病杂志》2011年第8期576-580,共5页Chinese Journal of Nephrology

基　　金：上海市科委重大项目（08DZ1900603）;闵行区重点学科建设项目

摘　　要：目的研究并发高血压的住院慢性肾脏病（CKD）患者的降压药使用和血压控制情况，以及其相关因素。方法对象为2009年3月至2010年4月期间于本院住院的并发高血压的CKD患者共726例，记录其基本资料、血压、降压药使用及其他相关资料，分析其用药方案及血压控制率。结果91．74％患者接受了降压治疗，分别有21．21％、22．59％、19．56％、28．37％患者使用1、2、3、≥4种降压药。CKD患者总体高血压控制率为42．4％，平均血压为（137．86±20．75）／（76．30±11．35）mmHg。CKD1＋2、3、4＋5期（未透析）、透析组的高血压控制率分别为50．8％、46．7％、42．0％、33．5％，各组问差异有统计学意义（P〈0．05）。非透析组高血压控制率（〈130／80ml／1Hg）显著高于透析组（〈140／90rnmHg）（44．9％比33．5％，P〈0．05）。血透组与腹透组高血压控制率差异无统计学意义（32．3％比38．7％，P〉0．05）。多因素Logistic回归分析显示，女性（优势比OR=1．787，95％叫1．045～3．056）和应用ACEI类降压药（OR=4．378，95％CI1．830～10．472）是高血压控制的有利因素；而脉乐差增大（OR=0．847，95％CI0．811～0．885）和并发糖尿病（OR=0．415，95％C10．188～0．919）是高血压控制的不利因素。结论住院CKD患者的高血压治疗率很高，但控制率仍较低。女性、ACEI类降压药是CKD患者血压控制的有利因素，而脉压差大、糖尿病是血压控制不良的独立危险因素。Objective To investigate the management and control of hypertension in patients with chronic kidney disease （CKD） and its associated factors. Methods Data of 726 in-patients with CKD and hypertension who hospitalized in our hospital from March 2009 to April 2010 were studied. Results 91.74% of patients was treated with antihypertensive medications, and 21.21%, 22.59%, 19.56%, 28.37% of patients received 1, 2, 3, ≥4 antihypertensive drugs, respectively. 42.4% of patients with CKD and hypertension could be controlled up to the standard, and the mean blood pressure was （137.86±20.75）/（76.30±11.35） mm Hg. There was significant difference among stage 1 plus 2, 3, 4 plus 5 （non-dialysis）, 5 （dialysis） kidney diseases, with the hypertension control rate being 50.8%, 46.7%, 42.0%, 33.5%, respectively. The hypertension control rate of non-dialysis patients was significantly higher than that of dialysis （44.9% vs 33.5%, P〈0.05）. There was no significant difference between blood dialysis group and peritoneal dialysis group （32.3% vs 38.7%, P〉0.05）. Multivariate Logistic regression analysis showed that female （OR=1.787, 95%CI 1.045-3.056）and ACEI application （OR=4.378, 95%CI 1.830-10.472） were positively associated with hypertension control. Whereas, diabetes （OR=0.415, 95%CI 0.188-0.919） and pulse pressure （OR =0.847, 95% CI 0.811-0.885） were associated with inadequate blood pressure control. Conclusions Despite almost universal hypertension treatment is used in patients with CKD and high blood pressure, the hypertension control rate is still suboptimal. Female and ACEI are positively associated with adequate hypertension control, whereas diabetes and pulse pressure are negatively associated with the standard.

关 键 词：肾疾病 慢性 高血压 血管紧张素转换酶抑制剂 糖尿病 

分 类 号：R544.1[医药卫生—心血管疾病]