The Prevalence And Influencing Factors Of Hypertension In Patients With MHD In Zhengzhou

Objective: To explore the prevalence and influencing factors of hypertension in patients with maintenance hemodialysis(MHD) in Zhengzhou.Methods: The study chose 472 medically stable cases of uremia patients treated with maintenance hemodialysis(MHD) more than three months in maintenance hemodialysis patients which came from the 7 blood purification centers in Zhengzhou during the period of October 2013 to March 2014. General information and laboratory data were collected, and we analyzed the prevalence of hypertension and blood pressure control in patients with MHD according to the guidelines for prevention and treatment of hypertension in China(revised edition in 2010).They were divided into three groups according to blood pressure(BP): normal BP group, well-controlled BP group, poorly-controlled BP. Gender,age,primary disease, dialysis time, body mass index(BMI), types of antihypertensive drugs, body weight gain, blood urea nitrogen(BUN), serum creatinine(Cr), uric acid(UA), parathyroid hormone(PTH), calcium(Ca), phosphorus(P), calcium-phosphorus product(Ca×P), riglycerides(TG), cholesterol(TC), hemoglobin(Hb), albumin(Alb) and Kt/V were contrasted among the three groups by employing the statistical methods such as single factor analysis of variance,chi square test,et al. And logistic regression analysis was used to analyze the related factors of blood pressure.Results: 1. The prevalence of hypertension:91.5% of 472 patients with MHD have been suffering from hypertension.The prevalence of hypertension in male and female patients with MHD were 92.68% and 89.73% respectively,and the prevalence rate in male was higher than female,but the difference was no statistically significant.The prevalence of hypertension in young,middle-aged and elderly patients were 87.70%,93.49% and 91.85%,respectively,but it was no statistically significant difference.2.Medication situation:The calcium channel blocker was the most used antihypertensive drugs in MHD patients,accounting for 93.06%,and the second medication was angiotensin converting enzymeinhibitor and angiotensin II receptor blockers, accounting for 81.94%.The proportion of patients who used 1,2,3,4 or more antihypertensive drugs were 14.35%,34.18%,29.40%,24.07% respectively.Patients using 1 antihypertensive drugs who chose CCB drugs accounted for 64.52%,In patients using 2 kinds of antihypertensive drugs, the choice of CCB combined with ACEI/ARB and the combination of beta blockers accounted for 46.04% and 30.22% respectively.3.The control of hypertension:In 432 maintenance hemodialysis patients,the control rate of hypertension was 45.37%, accounting for 196 cases,and 54.63% had uncontrolled hypertension.In the patients with poor blood pressure control,66.95% was grade 1 hypertension,27.54% was grade 2 hypertension,5.51% was grade 3 hypertension. Simple systolic hypertension accounted for 61.44%,mixed type hypertension accounted for 32.20%,and 6.36% was isolated diastolic hypertension. The control rate of hypertension in the male and female MHD patients were 44.36% and 46.99% respectively,and it was no statistically significance.The control rate of hypertension in the young,middle-aged and elderly patients were 38.32%,50.25% and 43.55%,and it was no statistically significance.Primary disease as chronic glomerular nephritis, diabetic nephropathy, hypertensive nephropathy in patients with hypertension control rate were 50.67%, 50.33%, 38.15%, primary disease because hypertensive in patients with hypertension control rate is lower, but the difference was not statistically significant; Control rates of hypertension in patients with 1, 2, 3 or more antihypertensive drugs were 53.22%,53.24%,38.53%, and the difference was statistically significant. And there was a difference in the blood pressure control rate of 3 kinds of antihypertensive drugs and 2 or more antihypertensive drugs.4. The influencing factors of hypertension: the differences of the age, gender, BMI, BUN, Cr, UA, TG, TC, Ca, P, Ca×P,Hb and Alb among three groups were not significant.Compared with other groups, the body weight gain and the PTH was higher in poorly-controlled BP group, and the Kt/V was lower, which were statistically significant(P<0.05). The difference that the body weight gain was higher and Kt/V was lower in well-controlled BP group than normal BP group was statistically significant(P<0.05). Multiple Logistic regression results showed that excessive weight gain, low Kt/V and high i PTH were the risk factors of poor blood pressure control in MHD patients.Conclusions: 1.The prevalence rate of hypertension in the maintenance hemodialysis patients in Zheng Zhou was high, and it was given priority to isolated systolic hypertension in the high blood pressure,however,the rate of blood pressure control was lower.2. Excessive weight gain during the interdialysis period, inadequate hemodialysis(low Kt/V) as well as high PTH were risk factors to hypertension in maintenance hemodialysis patients.