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慢性肾脏病合并高血压患者夜间血压控制状况及危险因素分析 被引量:13

Nighttime blood pressure control in hypertensive chinese chronic kidney disease patients
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摘要 目的 了解慢性肾脏病(CKD)合并高血压患者夜间血压控制状况及影响因素.方法 回顾性收集我科2010至2012年间接受过动态血压监测(ABPM)的CKD合并高血压住院患者的临床资料,包括年龄、性别、基础合并症(糖尿病、心血管疾病)、高血压治疗方案(联合用药、睡前用药)、eGFR、尿蛋白以及诊室血压资料,分析该人群夜间血压控制情况及相关危险因素.结果共有337例资料完整的患者纳入分析.其中212例(62.9%)为男性,平均年龄(47.4±17.3)岁,平均eGFR (46.6±40.9) ml· min-1·(1.73 m2)-1.诊室血压控制达标率(< 140/90 mmHg)为35.9%,ABPM全天血压控制达标率(<130/80 mmHg)为38.6%.夜间血压控制率(< 120/70 mmHg,22.8%)低于白天血压控制率(<135/85 mmHg,50.7%),差异有统计学意义(P< 0.001).在130例ABPM全天血压控制达标的患者中,有58例(44.6%)患者夜间血压控制未达标.尿蛋白水平(OR:1.151,95%CI:1.035~1.279)是夜间血压控制未达标的独立危险因素.268例(79.5%)患者为非杓型血压节律,其中100例患者(37.3%)为反杓型血压节律.夜间血压控制未达标是血压节律异常的独立危险因素(均P< 0.001).结论 夜间血压控制不达标在CKD合并高血压患者中普遍存在,并对血压节律产生影响.应重视ABPM在血压管理中的应用,以加强对夜间血压控制的评估及干预. Objective To evaluate the nighttime blood pressure(BP) control status of hypertensive Chinese chronic kidney disease (CKD) patients and related risk factors.Methods This cross-sectional study enrolled 337 hypertensive CKD in-patients.The clinical and ambulatory BP monitoring (ABPM) data were retrieved from the electronic database of the hospital.High ambulatory BP were defined as 〉130/80 mmHg (average 24-hour BP) and 〉135/85 mmHg (daytime)/〉120/70 mmHg (nighttime),respectively.Multivariable analysis was used to evaluate the risk factors for lack of nighttime BP control and circadian rhythm.Results There were 38.6% of the whole population had average 24-hour BP controlled.But only 22.8% of them achieved nighttime BP control,which was far less than the 50.7% of daytime BP control (P 〈 0.01).Even among those patients who achieved average 24-hour BP control shown by ABPM,there were still 44.6% of them with uncontrolled nighttime BP.Multiple analyses showed urinary protein excretion (OR:1.151,95%CI:1.035-1.279) was independent risk factor for lack of nighttime BP control.About 80% of patients presented with nondipping BP pattern,among whom 37.3% were presented with reverse-dipper pattern.Lack of nighttime BP control was independent risk factor for lack of normal circadian rhythm (both P〈0.001).Conclusions Lack of nighttime BP control was common in hypertensive CKD patients and contributed to the abnormal circadian rhythm.ABPM should be performed more commonly in clinical practice to help nighttime BP control in the future.
出处 《中华肾脏病杂志》 CAS CSCD 北大核心 2015年第5期327-332,共6页 Chinese Journal of Nephrology
关键词 肾疾病 高血压 血压监测 便携式 夜间血压 Kidney disease Hypertension Blood pressure monitoring,ambulatory Nighttime blood pressure
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  • 1Lv J, Ehteshami P, Samak MJ, et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta - analysis[J]. CMAJ, 2013, 185 (11): 949-957. 被引量:1
  • 2Gabbai FB, Rahman M, Hu B, et al. Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD[J]. Clin J Am Soc Nephrol, 2012, 7(11): 1770-1776. 被引量:1
  • 3Minutolo R, Agarwal R, Borrelli S, et al. Prognostic role of ambulatory blood pressure measurement in patients with nondialysis chronic kidney disease[J]. Arch Intern Med, 2011, 171(12): 1090-1098. 被引量:1
  • 4Redon J, Plancha E, Swift PA, et al. Nocturnal blood pressure and progression to end - stage renal disease or death in nondiabetic chronic kidney disease stages 3 and 4[J]. J Hypertens, 2010, 28(3): 602-607. 被引量:1
  • 5Mehta R, Drawz PE. Is nocturnal blood pressure reduction the secret to reducing the rate of progression of hypertensive chronic kidney disease[J]. Curr Hypertens Rep, 2011, 13(5): 378-385. 被引量:1
  • 6Zhang L, Wang F, Wang L, et al. Prevalence of chronic kidney disease in China: a cross-sectional survey[J]. Lancet, 2012, 379 (9818): 815-822. 被引量:1
  • 7Wang Y, Zhang L, Li X, et al. Improvement of awareness, treatment and control of hypertension among chronic kidney disease patients in China from 1999 to 2005[J]. Hypertens Res, 2009, 32(6): 444-449. 被引量:1
  • 8Ma YC, Zuo L, Chen JH, et al. Modified glomerular filtration rate estimating equation for Chinese patients with chronic kidney disease[J]. J Am Soc Nephrol, 2006, 17(10): 2937 - 2944. 被引量:1
  • 9The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical practice guideline for evaluation and management of CKD[J]. Kidney Int Suppl, 2013, 3(1): 19. 被引量:1
  • 10KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease[J]. Kidney Int Suppl, 2012,2(5): 337-414. 被引量:1

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