目的:肺移植是许多终末期肺部疾病的最终治疗方法。钙调神经磷酸酶抑制剂,对肺移植受者的免疫抑制至关重要,与继发性高血压有关,需要抗高血压治疗。此外,肺移植受者经常经历直立性低血压,偶尔源于自主神经功能障碍,但通常也被认为是降压治疗的副作用。我们的研究旨在评估体位血压不规则的频率,并研究抗高血压治疗的参与是肺移植受者发生的潜在危险因素。
方法:56个连续的肺移植受者,住院和门诊,从1999年至2013年,在苏黎世(瑞士)大学医院接受了监测。移植接受者接受了Schellong测试(主动站立测试)。我们的评估包含了他们最初的特征,如仰卧高血压的存在。我们计算了使用至少1种抗高血压药物与不使用抗高血压药物时发生体位性低血压的可能性比较的比值比。
结果:在肺移植受者中,25%的Schellong试验显示为阳性。在这个群体中,64%有仰卧位高血压,29%表现为直立性低血压的症状。在患者中,71%的人使用至少一种类型的抗高血压药物。服用至少1种类型的抗高血压药物与不服用抗高血压药物时显示体位性低血压的比值比为1.64(95%exactCI,0.39-6.90),P=.50。无论年龄大小,这一发现都保持一致,性别,住院或门诊状态,以及移植后的持续时间。
结论:体位血压失调在肺移植受者中普遍存在,经常没有明显的症状。在我们的队列中,抗高血压药物的使用并未增加体位性低血压的风险.
OBJECTIVE: Lung transplant is the ultimate treatment of many end-stage lung diseases. Calcineurin inhibitors, crucial in immunosuppression for lung transplant recipients, are linked to secondary hypertension, necessitating antihypertensive treatment. In addition, lung transplant recipients frequently experience orthostatic hypotension, occasionally stemming from autonomic dysfunction, but also commonly attributed as a negative side effect of antihypertensive treatment. Our study aimed to evaluate the frequency of orthostatic blood pressure irregularities and investigate the involvement of antihypertensive treatment as a potential risk factor in the occurrence among lung transplant recipients.
METHODS: Fifty-six consecutive lung transplant recipients, both inpatient and outpatient, at the University Hospital Zurich (Switzerland) were monitored from 1999 to 2013. Transplant recipients underwent a Schellong test (an active standing test). Our evaluation encompassed their initial traits, such as the existence of supine hypertension. We computed the odds ratio for the comparison of the likelihood of experiencing orthostatic hypotension while using a minimum of 1 type of antihypertensive medication versus absence of antihypertensive drugs.
RESULTS: Of the lung transplant recipients, 25% showed a positive Schellong test. Within this group, 64% had supine hypertension, and 29% displayed symptoms of orthostatic hypotension. Among the patients, 71% were using at least 1 type of antihypertensive medication. The odds ratio for showing orthostatic hypotension while taking at least 1 type of antihypertensive drug versus the absence of antihypertensive medications was 1.64 (95% exact CI, 0.39-6.90) with P = .50. This finding remained consistent regardless of age, sex, inpatient or outpatient status, and the duration since transplant.
CONCLUSIONS: Orthostatic blood pressure dysregulation is prevalent among lung transplant recipients, frequently without noticeable symptoms. In our cohort, the use of antihypertensive medications did not elevate the risk of orthostatic hypotension.