만성 혈액투석 환자의 고혈압 유병률과 혈압과 심혈관 사망률의 관계 = Prevalence of Hypertension and Impact of Predialysis Systolic Blood Pressure on Cardiovascular Mortality in Chronic Hemodialysis Patients

다국어 초록 (Multilingual Abstract)

Background:Hypertension is very common in chronic hemodialysis patients. But impact of predialysis systolic blood pressure on cardiovascular mortality is not clear and it's investigation is not thoroughgoing enough in Korea.
Methods:We assessed the prevalence and control rate of hypertension in a cross sectional study of 81 clinically stable hemodialysis patients who had been treated with regular hemodialysis sessions in the Hanyang University Guri Hospital. To investigate the impact of predialysis systolic blood pressure on cardiovascular mortality, we retrospectively reviewed in May 2001 predialysis blood pressure and covariable factors of 115 hemodialysis patients who were monitored from the start of hemodialysis for more than 2 months between May 2001 and May 2004 in the Hanyang University Guri Hospital and local dialysis centers. Exclusion criteria were as follows:change to CAPD, transplantation, transfer to another dialysis center, non compliant, death due to accident and self withdrawal and hemodialysis for less than 2 months.
Results:The majority of hemodialysis patients (83%) take antihypertensive medications. Pre and post dialysis mean blood pressure was 153.2±14.5/86.9±4.7 mmHg, 145.5±17.1/84.2±5.2 mmHg respectively. Predialysis systolic blood pressure that was higher than 140 mmHg documented in 83% of patients. On the other side, predialysis diastolic blood pressure that was higher than 90 mmHg was only seen in 23 % of patients. Predialysis systolic hypertension was not associated with an increase in short term cardiovascular mortality. On the other hand, hypoalbuminemia and diabetes mellitus were associated with an increase in short term cardiovascular mortality.
Conclusion:The present study suggests that control of hypertension, particularly systolic hypertension, in chronic hemodialysis patients, is insufficient, despite the use of antihypertensive drugs. The overall impact of predialysis systolic hypertension on cardiovascular mortality tends to be increased, but it was not associated with short term cardiovascular mortality.

국문 초록 (Abstract)

목 적:대부분 만성 혈액투석 환자에서 고혈압은 존재하나 심혈관 사망에 미치는 영향은 명확하지 않다. 이에 저자들은 만성 혈액투석 환자의 고혈압 유병률 및 투석 전 수축기혈압이 심혈관 사망에 미치는 영향에 대해서 알아보고자 하였다.
방 법:2004년 3월 한양대학교 구리병원에서 정규적으로 혈액투석 중인 81명을 대상으로 투석 전후 혈압을 측정하여 고혈압의 유병률과 치료반응 정도를 평가하고자 단면연구를 시행하였고, 한양대학교 구리병원과 인접 투석센터에서 혈액투석 중인 115명의 환자를 대상으로 2001년 3월부터 2004년 2월까지 투석 전 수축기혈압이 심혈관 사망에 미치는 영향에 대해 후향적 코호트 연구를 시행하였다.
결 과:단면연구에서 총 81명 중 68명 (84%)이 항고혈압 약제로 치료 중이었고, 투석 전후 평균혈압은 각각 153.2±14.5/87.0±4.7 mmHg, 145.6±17.1/84.0±5.3 mmHg이었다. 투석 전 수축기혈압이 140 mmHg 이상인 경우는 83%이었다. 반면에 투석 전 확장기혈압이 90 mmHg 이상인 경우는 23%이었다. 투석 전후 수축기혈압이 110 mmHg 이하인 경우는 없었다. 3년간 관찰한 후향적 코호트 연구에서는 심혈관 질환에 의한 사망이 55%로 가장 높은 사망원인이었다. 저알부민혈증과 당뇨병이 심혈관사망과 통계적으로 유의한 관련이 있었고, 투석 전 수축기혈압과 심혈관 사망률과의 단변량 분석에서 혈압이 증가할수록 심혈관사망이 증가하였으나 통계적으로 유의한 차이는 없었다.

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