中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2015年
5期
327-332
,共6页
肾疾病%高血压%血压监测,便携式%夜间血压
腎疾病%高血壓%血壓鑑測,便攜式%夜間血壓
신질병%고혈압%혈압감측,편휴식%야간혈압
Kidney disease%Hypertension%Blood pressure monitoring,ambulatory%Nighttime blood pressure
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.
目的 瞭解慢性腎髒病(CKD)閤併高血壓患者夜間血壓控製狀況及影響因素.方法 迴顧性收集我科2010至2012年間接受過動態血壓鑑測(ABPM)的CKD閤併高血壓住院患者的臨床資料,包括年齡、性彆、基礎閤併癥(糖尿病、心血管疾病)、高血壓治療方案(聯閤用藥、睡前用藥)、eGFR、尿蛋白以及診室血壓資料,分析該人群夜間血壓控製情況及相關危險因素.結果共有337例資料完整的患者納入分析.其中212例(62.9％)為男性,平均年齡(47.4±17.3)歲,平均eGFR (46.6±40.9) ml· min-1·(1.73 m2)-1.診室血壓控製達標率(＜ 140/90 mmHg)為35.9％,ABPM全天血壓控製達標率(＜130/80 mmHg)為38.6％.夜間血壓控製率(＜ 120/70 mmHg,22.8％)低于白天血壓控製率(＜135/85 mmHg,50.7％),差異有統計學意義(P＜ 0.001).在130例ABPM全天血壓控製達標的患者中,有58例(44.6％)患者夜間血壓控製未達標.尿蛋白水平(OR:1.151,95％CI:1.035～1.279)是夜間血壓控製未達標的獨立危險因素.268例(79.5％)患者為非杓型血壓節律,其中100例患者(37.3％)為反杓型血壓節律.夜間血壓控製未達標是血壓節律異常的獨立危險因素(均P＜ 0.001).結論 夜間血壓控製不達標在CKD閤併高血壓患者中普遍存在,併對血壓節律產生影響.應重視ABPM在血壓管理中的應用,以加彊對夜間血壓控製的評估及榦預.
목적 료해만성신장병(CKD)합병고혈압환자야간혈압공제상황급영향인소.방법 회고성수집아과2010지2012년간접수과동태혈압감측(ABPM)적CKD합병고혈압주원환자적림상자료,포괄년령、성별、기출합병증(당뇨병、심혈관질병)、고혈압치료방안(연합용약、수전용약)、eGFR、뇨단백이급진실혈압자료,분석해인군야간혈압공제정황급상관위험인소.결과공유337례자료완정적환자납입분석.기중212례(62.9％)위남성,평균년령(47.4±17.3)세,평균eGFR (46.6±40.9) ml· min-1·(1.73 m2)-1.진실혈압공제체표솔(＜ 140/90 mmHg)위35.9％,ABPM전천혈압공제체표솔(＜130/80 mmHg)위38.6％.야간혈압공제솔(＜ 120/70 mmHg,22.8％)저우백천혈압공제솔(＜135/85 mmHg,50.7％),차이유통계학의의(P＜ 0.001).재130례ABPM전천혈압공제체표적환자중,유58례(44.6％)환자야간혈압공제미체표.뇨단백수평(OR:1.151,95％CI:1.035～1.279)시야간혈압공제미체표적독립위험인소.268례(79.5％)환자위비표형혈압절률,기중100례환자(37.3％)위반표형혈압절률.야간혈압공제미체표시혈압절률이상적독립위험인소(균P＜ 0.001).결론 야간혈압공제불체표재CKD합병고혈압환자중보편존재,병대혈압절률산생영향.응중시ABPM재혈압관리중적응용,이가강대야간혈압공제적평고급간예.
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.
