背景 透析病患因心血管疾病死亡的比例是一般沒有腎臟衰竭病人的10-20 倍。對於透析病患， 高血壓是併發心血管疾病及腦血管疾病重要的危險因子。大約有80%的慢性透析病人有高血壓， 所以挑選適當的高血壓治療藥物很重要。血管收縮素轉化脢抑制劑及血管收縮素受體阻斷劑主 要是用來治療高血壓及心臟衰竭。最近的研究顯示，血管收縮素轉化脢抑制劑及血管收縮素受體阻斷劑對末期腎臟病患有好的療效，但是他們的效果仍不明確。因此，我們設計了回顧性的研究，去評估血管收縮素轉化脢抑制劑及血管收縮素受體阻斷劑和其他抗高血壓藥物對於慢性透析病人在長期臨床上的差異。 方法 我們使用了國家健康保險研究資料庫去做全國性的比對的事件對照研究分析。我們比對了病人的年齡、性別及糖尿病得病情形。我們的研究人口包括，2004/1/1 到2004/12/31 期間的末期腎臟病的新發個案且有高血壓的病人，病人因為服用不同的抗高血壓藥物而被分到不同群組。追縱時間是從透析開始至死亡或是至研究結束時間 (2008/12/31)。我們使用了卡方檢定、t 檢定、Kaplan-Meier 存活分析、對數等級檢定及Cox 比例風險模型做進一步的分析。 結果 這個研究包含了2262 個有高血壓的血液透析病人。在這個研究中，有251 (11.2%)人被歸類為事件組，他們服用的是血管收縮素轉化脢抑制劑或血管收縮素受體阻斷劑；有1997 (88.8%)人被歸類為控制組，他們服用的是除了血管收縮素轉化脢抑制劑或血管收縮素受體阻斷劑的其他抗高血壓藥物。基本的人口特性包括性別、年齡、共病情形及死亡率，在事件組與控制組之間基本研究人口的特性很相似，但用藥的情況 (控制組1.06 ± 0.24 及對照組1.74 ± 0.84,P<0.0001)與因腦血管疾病的住院率 (P=0.006)在事件組與控制組有差異。 結論 在五年的追蹤期裡，我們發現事件組因腦血管疾病住院的情形相較低。這些發現或許可以提供我們一些臨床的建議，有高血壓的透析病患應該優先服用血管收縮素轉化脢抑制劑及血管收縮素受體阻斷劑。 Background The risk of cardiovascular mortality in dialysis patients is 10 to 20-fold than in age-matched and sex-matched general population without kidney damage. Hypertension is one of the most important factors of cardiovascular and cerebrovascular complications on dialysis patients. About 80% of dialysis patients are hypertensive, so it’s important to choose appropriate hypertensive agents. Angiotensin-converting enzyme inhibitors (ACEI) and Angiotensin receptor blockers (ARB) were directed at treating hypertension and heart failure. Recent researches stated that ACEI and ARB were benefit on chronic dialysis patients, but the outcomes were still uncertain. Therefore, we used the retrospective study to evaluate the clinical outcome between ACEI/ARB and other antihypertensive agents on chronic dialysis patients. Methods We performed a retrospective matched case-control study using the population-based database from National Health Insurance Research Database (NHIRD). Patients’ age, gender and diabetes mellitus were matched. From January 2004 to December 2004, new onset end-stage renal disease patients with hypertension were included and were grouped according to different antihypertensive agents. They were followed up from the date of dialysis initiation till death or the end of the study. Chi-squared test, t-test, Kaplan-Meier survival analysis, log-rank test and Cox-proportional hazard model were used for analysis. Results A total of 2262 patients having hypertension who started hemodialysis (HD) between January 2004 and December 2004 were included. There were 251 (11.2%) patients treated with ACEI /ARB in the case group and 1997 (88.8%) patients treated with other hypertensive agents in the control group. The baseline characteristics including age, gender, comorbidities and mortality between two groups are similar except the kinds of hypertensive agents (1.06 ± 0.24 in case group, 1.74 ± 0.84 in control group, p<0.0001) and lower hospitalization rate of cerebrovascular disease (CVA) in case group (P =0.0061). Conclusions In the five-year follow-up, we found that case group has a lower hospitalization rate in CVA than control group. However, hospitalization rate of other factors and all cause mortality rate showed lower significant difference. Such findings may provide clinical implication about ACEI/ARB on hypertensive dialysis patients.
