■钙通道阻滞剂(CCB)是接受血液透析(HD)的患者中常见的抗高血压药。尽管如此,CCB与透析中低血压(IDH)的关系,与心血管疾病发病率和死亡率相关的重要不良结局,在很大程度上仍未探索。
■使用来自血液透析(HEMO)研究的动力学建模会话数据,随机效应回归模型适用于评估使用CCB和不使用IDH的相关性(如果HD前SBP<160mmHg,则定义为收缩压[SBP]<90mmHg;如果HD前SBP≥160mmHg,则定义为<100mmHg).模型根据年龄进行了调整,生物性别(区分男性和女性),种族,随机Kt/V和通量分配,心力衰竭,缺血性心脏病,外周血管疾病,糖尿病,血尿素氮,超滤率,访问类型,pre-HDSBP,和其他抗高血压药。
■数据可用于1838名患者和64,538个疗程。在基线,49%的患者被处方CCB。IDH的总频率为14%,从最低点到最低点SBP的平均下降为33±15mmHg。CCB使用与较低的IDH调整风险相关,与未使用相比(发生率比[IRR]:0.84;95%置信区间[CI]:0.78-0.89)。与最高四分位数(IRR:0.86;95%CI:0.77-0.97;P-交互作用<0.001)相比,HD前SBP最低四分位数(IRR:0.77;95%CI:0.70-0.85)的相关性最为明显。
■在接受HD的患者中,CCB的使用与较低的IDH风险相关,独立于HD前SBP和其他抗高血压药的使用。需要进行机制研究,以更好地了解CCB和其他抗高血压药物对接受HD患者透析前后血压(BP)参数的影响。
UNASSIGNED: Calcium channel blockers (CCBs) are common antihypertensive agents among patients receiving hemodialysis (HD). Despite this, the association of CCBs with intradialytic hypotension (IDH), an important adverse outcome that is associated with cardiovascular morbidity and mortality, remains largely unexplored.
UNASSIGNED: Using kinetic modeling sessions data from the Hemodialysis (HEMO) Study, random effects regression models were fit to assess the association of CCB use versus nonuse with IDH (defined as systolic blood pressure [SBP] < 90 mm Hg if pre-HD SBP < 160 mm Hg or < 100 mm Hg if pre-HD SBP ≥160 mm Hg). Models were adjusted for age, biological sex (distinguishing between males and females), race, randomized Kt/V and flux assignments, heart failure, ischemic heart disease, peripheral vascular disease, diabetes mellitus, blood urea nitrogen, ultrafiltration rate, access type, pre-HD SBP, and other antihypertensives.
UNASSIGNED: Data were available for 1838 patients and 64,538 sessions. At baseline, 49% of patients were prescribed CCBs. The overall frequency of IDH was 14% with a mean decline from pre- to nadir-SBP of 33 ± 15 mm Hg. CCB use was associated with lower adjusted risk of IDH, compared with no use (incidence rate ratio [IRR]: 0.84; 95% confidence interval [CI]: 0.78-0.89). The association was most pronounced for those in the pre-HD SBP lowest quartile (IRR: 0.77; 95% CI: 0.70-0.85); compared with the highest quartile (IRR: 0.86; 95% CI: 0.77-0.97; P-interaction < 0.001).
UNASSIGNED: Among patients receiving HD, CCB use was associated with a lower risk of developing IDH, independent of pre-HD SBP and other antihypertensives use. Mechanistic studies are needed to better understand the effects of CCB and other antihypertensives on peridialytic blood pressure (BP) parameters among patients receiving HD.