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