CAJ | 학술논문

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) mm Hg。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％，各组间差异有统计学意义(P＜0.05)。非透析组高血压控制率(＜130/80 mm Hg)显著高于透析组(＜140/90 mm Hg)(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％CI 1.045～3.056)和应用ACEI类降压药(OR=4.378，95％CI 1.830～10.472)是高血压控制的有利因素；而脉压差增大(OR =0.847，95％CI 0.811～0.885)和并发糖尿病(OR =0.415，95％CI 0.188～0.919)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。
목적 연구병발고혈압적주원만성신장병(CKD)환자적강압약사용화혈압공제정황，이급기상관인소。방법 대상위2009년3월지2010년4월기간우본원주원적병발고혈압적CKD환자공726례，기록기기본자료、혈압、강압약사용급기타상관자료，분석기용약방안급혈압공제솔。결과 91.74％환자접수료강압치료，분별유21.21％、22.59％、19.56％、28.37％환자사용1、2、3、≥4충강압약。CKD환자총체고혈압공제솔위42.4％，평균혈압위(137.86±20.75)/(76.30±11.35) mm Hg。CKD1+2、3、4+5기(미투석)、투석조적고혈압공제솔분별위50.8％、46.7％、42.0％、33.5％，각조간차이유통계학의의(P＜0.05)。비투석조고혈압공제솔(＜130/80 mm Hg)현저고우투석조(＜140/90 mm Hg)(44.9％비33.5％，P＜0.05)。혈투조여복투조고혈압공제솔차이무통계학의의(32.3％비38.7％，P＞0.05)。다인소Logistic회귀분석현시，녀성(우세비OR= 1.787，95％CI 1.045～3.056)화응용ACEI류강압약(OR=4.378，95％CI 1.830～10.472)시고혈압공제적유리인소；이맥압차증대(OR =0.847，95％CI 0.811～0.885)화병발당뇨병(OR =0.415，95％CI 0.188～0.919)시고혈압공제적불리인소。결론주원CKD환자적고혈압치료솔흔고，단공제솔잉교저。녀성、ACEI류강압약시CKD환자혈압공제적유리인소，이맥압차대、당뇨병시혈압공제불량적독립위험인소。
Objective To investigate the management and control of hypertension in patients with chronic kidney disease (CKD) and its associated factors. Methods Data of 726in-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.ConclusionsDespite 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.