| Objective 1.To observe and describe the clinical characteristics of peritoneal dialysis(PD)patients with resistant hypertension(RH),and analyze the risk factors of PD patients with RH by cross-sectional analysis.2.To investigate the antihypertensive efficacy of angiotensin II-receptor neprilysin inhibitor(ARNI)on PD patients with RH,and to evaluate the effect and safety of ARNI in PD patients.Methods 1.The first part was a single-center,cross-sectional observational study.Patients in the regular and stable PD treatment in our PD center were enrolled.The prevalence of RH in PD patients with hypertension was estimated based on home blood pressure(BP),and the patients were divided into RH group and non-RH group.The demographic data,lifestyle data,serological indicators,BP based on office and home,medication adherence,and drug combination of the patients in the two groups were collected and compared,and the Logistic regression analysis was used to analyze the risk factors related to RH.2.The second part was a single-center,prospective,cohort,self-controlled study.Patients who received regular and stable PD treatment with RH in our PD center from March2021 to June 2021 were enrolled.The patients were treated with standardized titration protocol of sacubitril/valsartan(SV)based on the original antihypertensive regimen for 6months.The endpoints were as follows:(1)Various indicators of ambulatory blood pressure(ABP): The mean BP effectively recorded by ambulatory blood pressure monitoring(ABPM);Dropping rates of nocturnal BP;blood pressure variability(BPV)parameters,including standard deviation(SD)and coefficient of variation(CV)of the mean systolic and diastolic BP,(2)The control rates of BP.The 24 h BP before and after treatment was monitored with a non-invasive portable cuff BP meter,and the ABPM data,biochemical indexes,dialysis-related data,and adverse events before and after the completion of the SV titration protocol were compared and analyzed.Results 1.(1)A total of 309 PD patients were included in the first part of this study,of those,149 patients were classified as RH.The prevalence of RH in hypertension PD patients was estimated at 48.2% based on home BP.(2)Compared with the non-RH group,the patients in the RH group had more males and were younger,and more patients were with cardiovascular diseases(CVD).The proportion of patients who took regular exercise was lower,and their medication adherence was poorer.Besides,their hemoglobin,albumin,and Kt/V were lower,and their serum creatinine was higher(P<0.05).(3)Low serum albumin,poor residual renal function,irregular physical exercise,and poor medication compliance were the independent risk factors for RH in PD patients(P<0.05).2.(1)A total of 67 PD patients were included in the second part of this study,the 24h-BP was 150.51±13.83/92.07±11.42 mm Hg at baseline.After a median of 8(4,12.5)months of follow-up,a total of 17 patients dropped-out and 50 patients completed the study.(2)After treated with SV,the mean reduction in 24h-BP was 9.52/7.55 mm Hg(p<0.001),and the mean reduction in d BP and n BP were 10.82/8.4(p<0.001)and 6.93/4.95 mm Hg(p<0.05),respectively.(3)After treatment,the patients’ control rate of BP was improved from 14.90%to 44.80%(P<0.001).(4)The 24 h SBP-SD,24 h DBP-SD,d DBP-SD and 24 h DBP-CV were significantly lower than those before treatment(P<0.05).(5)No serious adverse events were observed.Conclusion 1.RH was very common in the PD hypertensive patients with the prevalence of 48.2%.Low serum albumin,poor residual renal function,irregular physical exercise,and poor medication compliance were the independent risk factors for RH in PD patients(P<0.05).2.The SV,as an anti-hypertention drug,could effectively decrease multiple ABP indicators and increased the control rates of BP increased from 14.90% to 44.80% in PD patients with RH.The safety and tolerance were favorable. |
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