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目的了解偶测血压正常的慢性肾脏病(CKD)患者的动态血压特点。方法选择350例CKD1至5期偶测血压正常的患者,根据血压水平分为血压正常组(146例)和血压高值组(204例),另选择50名健康者为正常对照组。应用美国Spacelab无创便携式动态血压监测仪测量24h(8:00—次日8:00)、日间(6:00—22:00)、夜间(22:00—次日6:00)的动态血压数据(包括收缩压、舒张压、血压负荷、平均动脉压)的均值。每例患者仅统计日间动态血压升高(又称隐性高血压)、夜间动态血压升高和24h动态血压升高其中一种动态血压升高类型,不重复统计。观察CKD患者的动态血压、血压模式和动态血压负荷情况,3组患者隐性高血压和昼夜节律消失的发生情况,并比较3组患者的偶测血压、动态血压和动态血压负荷值。结果 350例偶测血压正常的CKD患者中,动态血压升高147例(42.0%),其中隐性高血压69例(19.7%);昼夜节律消失199例(56.9%);动态血压负荷升高204例(58.3%,以夜间动态血压负荷升高为主)。血压正常组隐性高血压发生率为11.0%(16/146),显著低于血压高值组的26.0%(53/204,P<0.01);正常对照组出现昼夜节律消失4例(8.0%)。血压正常组的偶测血压(收缩压、舒张压)均显著低于正常对照组(P值均<0.01),夜间动态血压(夜间收缩压、夜间舒张压)均显著高于正常对照组(P值均<0.01);血压高值组的偶测血压、24h动态血压、日间动态血压、夜间动态血压均显著高于正常对照组和血压正常组(P值均<0.01)。血压正常组的夜间动态血压负荷均显著高于正常对照组(P值均<0.01);血压高值组的24h血压负荷、日间动态血压负荷、夜间动态血压负荷均显著高于正常对照组和血压正常组(P值均<0.01);血压高值组和血压正常组的日间收缩压负荷显著高于同组的夜间收缩压负荷(P值均<0.01),而日间舒张压负荷显著低于同组的夜间舒张压负荷(P值均<0.01)。结论在偶测血压正常的CKD患者中,存在动态血压均值升高、隐性高血压、夜间高血压、血压负荷和昼夜节律消失的情况,应当引起重视。
Objective To investigate the ambulatory blood pressure characteristics of patients with chronic kidney disease (CKD) who have even measured blood pressure. Methods A total of 350 patients with CKD level 1-5 were enrolled in this study. Patients were divided into two groups according to their blood pressure: normotensive group (n = 146) and high blood pressure group (n = 204). Another 50 healthy controls were selected as normal control group. Application of the United States Spacelab noninvasive portable ambulatory blood pressure monitor 24h (8:00 - the next day 8:00), during the day (6: 00-22: 00), nighttime (22:00 - the next day 6:00) ambulatory blood pressure Data (including systolic pressure, diastolic blood pressure, blood pressure load, mean arterial pressure) mean. Each patient only statistics day dynamic blood pressure (also known as recessive hypertension), nocturnal ambulatory blood pressure and 24h ambulatory blood pressure, one of the type of dynamic blood pressure, non-repeatable statistics. Observe the dynamic blood pressure, blood pressure pattern and ambulatory blood pressure load in patients with CKD, the incidence of occult hypertension and circadian rhythm disappearance in 3 groups, and compare the occasional blood pressure, ambulatory blood pressure and ambulatory blood pressure load in 3 groups. Results Of the 350 cases of CKD patients with even-normal blood pressure, 147 cases (42.0%) had elevated ambulatory blood pressure, of which 69 cases (19.7%) had implicit hypertension, 199 cases (56.9%) had circadian rhythm disappearance, 204 cases (58.3%, mainly due to increased nocturnal ambulatory blood pressure). In the normotensive group, the incidence of occult hypertension was 11.0% (16/146), significantly lower than that in the high blood pressure group (26.0%, 53/204, P <0.01). In the normal control group, the circadian rhythm disappeared in 4 cases (8.0% ). The even blood pressure (systolic pressure and diastolic pressure) in normotensive group were significantly lower than those in normal control group (all P <0.01), nocturnal ambulatory blood pressure (nocturnal systolic pressure and nocturnal diastolic pressure) were significantly higher than those in normal control group (P (P <0.01). The mean blood pressure, 24h ambulatory blood pressure, ambulatory ambulatory blood pressure and nocturnal ambulatory blood pressure in high blood pressure group were significantly higher than those in normal control group and normal blood pressure group (all P <0.01). The nocturnal ambulatory blood pressure load in the normotensive group was significantly higher than that in the normal control group (P <0.01). The hs-BP, daytime ambulatory blood pressure and nocturnal ambulatory blood pressure were significantly higher in the high blood pressure group than in the normal control group and (P <0.01). The systolic blood pressure load of high blood pressure group and normal blood pressure group were significantly higher than that of the same group (P <0.01), while the diastolic blood pressure load of day was significantly higher Lower than the same group of nighttime diastolic pressure load (P <0.01). Conclusions In patients with CKD with even-normal blood pressure, there is an increase in mean of ambulatory blood pressure, occult hypertension, nocturnal hypertension, blood pressure load and disappearance of circadian rhythms, which deserve attention.