高血压患者血压昼夜节律与早期肾损害的关系

The relationship between blood pressure circadian rhythm and early renal damage in patients with primary hypertension

    摘要
  • 摘要: 目的探讨原发性高血压患者血压昼夜节律与早期肾损害的关系。方法纳入原发性高血压患者225例进行24h动态血压监测,计算夜间血压下降率、24h动态脉压（24hPP）及动态脉压指数（PPI,PPI=24hPP/24h收缩压）。根据昼夜血压变异性将研究对象分为夜间血压下降率≥10%（n=76）和夜间血压下降率<10%（n=149）两组,其中夜间血压下降率≥20%为超杓型组（n=6）,夜间血压下降率10%20%为杓型组（n=70）,夜间血压下降率0～10%为非杓型组（n=88）,夜间血压下降率<0为反杓型组（n=61）。以Cockcroft-Gault及简化肾脏病膳食改良试验（MDRD）公式计算估算的肾小球滤过率（eGFR）,测定空腹血糖、血尿素氮、血肌酐、胱抑素C、血脂、血尿酸及尿微量白蛋白（MA）水平。分析血压昼夜节律与早期肾损害的关系。结果夜间血压下降率<10%组eGFR水平较夜间血压下降率≥10%组降低MDRD公式计算:（80.6±21.8）比（97.3±24.2）mL/（min·1.73 m2）,P<0.01;Cockcroft-Gault公式计算:70.4（53.6～89.9）比91.2（76.0～113.1）mL/（min·1.73 m2）,P<0.01,而尿MA水平15.6（11.0～43.3）比11.8（10.8～22.3）mg/L,P<0.05以及胱抑素C水平1.0（0.8～1.3）比0.9（0.7～1.1）,P<0.05增加。分层分析结果显示,杓型组和非杓型组患者的eGFR水平高于反杓型组,而尿MA水平低于反杓型组（P<0.05）;杓型组患者的eGFR水平高于非杓型组（P<0.05）。夜间血压下降率<10%组的24hPP、PPI较夜间血压下降率≥10%组增高56（47～63）比50（44～58）mm Hg,0.42±0.07比0.39±0.06;均P<0.05。多因素线性回归分析结果显示血尿素氮、胱抑素C及PPI是eGFR（MDRD）的影响因素,胱抑素C、白天平均舒张压、24h平均舒张压、血尿酸及血尿素氮是eGFR（Cockcroft-Gault）的影响因素。结论与杓型高血压患者比较,非杓型和反杓型高血压患者早期肾损害的指标均异常升高,提示血压昼夜节律减弱或消失与早期肾损害密切相关。

     

    Abstract: Objective To investigate the relationship between blood pressure circadian rhythm and early renal damage in patients with primary hypertension. Methods A total of 225 hypertensive patients were divided into two groups:the nocturnal blood pressure decline rate of＜10%（n=149）or≥10%（n=76）. Additionally,supperdipper group was defined as nocturnal blood pressure decline rate≥20%（n=6）,dipper group as 10%-20%（n=70）,non-dipper group as 0-10%（n=88）and anti-dipper group as＜0（n=61）. Nocturnal blood pressure decline rate,24 hpulse pressure（24hPP）and pulse pressure index（PPI）were determined by 24h-ambulatory blood pressure monitoring. Estimated glomerular filtration rate（eGFR）was calculated by modification of diet in renal disease study（MDRD）and Cockcroft-Gault equations,respectively. Fasting plasma glucose,blood urea nitrogen（BUN）,serum creatinine（Scr）,cystatin C（Cys-C）,blood lipids,uric acid（UA）and urine micro-albumin（MA）were measured. The relationship between blood pressure circadian rhythm and early renal damage in patients with primary hypertension was analyzed. Results Patients with nocturnal blood pressure decline rate＜10% had significantly lower eGFR level （80.6±21.8）vs（97.3±24.2）mL/（min·1.73m2）by MDRD equation,P＜0.01;70.4（53.6-89.9）vs 91.2（76.0-113.1）mL/（min·1.73m2）by Cockcroft-Gault equation,P＜0.01,and higher MA 15.6（11.0-43.3）vs 11.8（10.8-22.3）mg/L,P＜0.05and Cys-C levels1.0（0.8-1.3）vs 0.9（0.7-1.1）mg/L,P＜0.05than control patients. Patients in the dipper group and non-dipper group had remarkably higher eGFR level and lower MA level than those in the anti-dipper group（P＜0.05）. Patients in the dipper group had significantly higher eGFR level than those in the non-dipper group（P＜0.05）. Compared to patients with nocturnal blood pressure decline rate≥10%,24 hPP and PPI were significantly higher in patients with nocturnal blood pressure decline rate＜10%56（47-63）vs 50（44-58）mm Hg,0.42±0.07 vs 0.39±0.06;both P＜0.05.Multiple linear regression analyses suggested a significant correlation of eGFR calculated by MDRD equation with BUN,Cys-C and PPI,but a significant correlation of eGFR calculated by Cockcroft-Gault equation with Cys-C,daytime diastolic blood pressure（dDBP）,24 hour diastolic blood pressure（24hDBP）,UA and BUN. Conclusion The indexes reflecting early renal injury were significantly associated with the non-and anti-dipper hypertension relative to the dipper hypertension,suggesting a close relation between abnormal circadian rhythm of blood pressure and early renal damage.

     

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