Robles N R, Cancho B, Crespo E, Sanchez Casado E
Unidad de Hipertensión Arterial, Sección de Nefrología, Hospital Infanta Cristina, Ctra. de Portugal, s/n. 06080 Badajoz.
Nefrologia. 2001 Jan-Feb;21(1):65-70.
High blood pressure is both a cause and a manifestation of renal disease. It has an increasing prevalence among renal patients renal function is declining. Blood pressure is not a constant value, but it shows a high intrinsic and extrinsic variability. It is common to find striking discordances between blood pressure values and target organ damage. The average values obtained through ambulatory blood pressure monitoring (ABPM) are better related with cardiovascular morbility and mortality than office measurement, even in renal disease patients. We report the experience with ABPM on 51 renal patients. None of them was on renal replacement therapy. In 7 out of 14 non treated patients ABPM showed clinic hypertension only. Mean age of truly hypertensive patients was higher, but this difference was not significant (normotensive 31.7 +/- 17.1; hypertensive 49.4 +/- 17.9 years, p < 0.1). There were no sex differences (normotensive, 5 males and 2 females; hypertensive, 4 males and 3 females). Three normotensive patients had chronic renal failure, and as did 6 hypertensive patients (p < 0.1). There were no differences in night-time drop either for systolic (normotensive 3.7 +/- 3.5 hypertensive 6.1 +/- 8.9%) or for diastolic blood pressure (normotensive 10.4 +/- 4.7 hypertensive 6.2 +/- 8.9%). Thirty-seven patients who were on antihypertensive drug treatment: 23 (68.2%) showed hypertension after the ABPM and 14 (37.8%) have normal blood pressure values, more over, 4 of these 14 patients showed hypotension. There were neither age differences between the groups (normotensive 49.0 +/- 12.5, hypertensive 51.9 +/- 15.4 years), nor sex differences (normotensive 9 males and 5 females, hypertensive 11 males and 12 females). The prevalence of renal failure was similar (normotensive, 85.7%; hypertensive, 82.6%). Mean night-time drop was not different (SBP, normotensive 6.1 +/- 7.6 hypertensive 7.2 +/- 7.6%; DBP, normotensive 9.0 +/- 8.3 hypertensive 13.5 +/- 7.6%). ABPM is a helpful diagnostic tool in renal disease as in the non complicated essential hypertension patient, both for experimental and for clinical purposes.
高血压既是肾脏疾病的病因，也是其表现形式。在肾功能下降的肾病患者中，高血压的患病率不断上升。血压并非一个恒定值，而是具有较高的内在和外在变异性。血压值与靶器官损害之间常常存在显著差异。即使在肾病患者中，通过动态血压监测（ABPM）获得的平均值与心血管发病率和死亡率的相关性也比诊室测量更好。我们报告了对51例肾病患者进行ABPM的经验。他们均未接受肾脏替代治疗。在14例未治疗的患者中，7例ABPM仅显示诊所高血压。真正高血压患者的平均年龄较高，但差异不显著（血压正常者31.7±17.1岁；高血压患者49.4±17.9岁，p<0.1）。不存在性别差异（血压正常者，男性5例，女性2例；高血压患者，男性4例，女性3例）。3例血压正常的患者患有慢性肾衰竭，6例高血压患者也患有慢性肾衰竭（p<0.1）。收缩压的夜间下降幅度（血压正常者3.7±3.5，高血压患者6.1±8.9%）或舒张压的夜间下降幅度（血压正常者10.4±4.7，高血压患者6.2±8.9%）均无差异。37例接受抗高血压药物治疗的患者：23例（68.2%）ABPM后显示高血压，14例（37.8%）血压值正常，此外，这14例患者中有4例显示低血压。两组之间在年龄上无差异（血压正常者49.0±12.5岁，高血压患者51.9±15.4岁），在性别上也无差异（血压正常者，男性9例，女性5例；高血压患者，男性11例，女性12例）。肾衰竭的患病率相似（血压正常者，85.7%；高血压患者，82.6%）。平均夜间下降幅度无差异（收缩压，血压正常者6.1±7.6，高血压患者7.2±7.6%；舒张压，血压正常者9.0±8.3，高血压患者13.5±7.6%）。ABPM对于肾病患者如同对无并发症的原发性高血压患者一样，无论是在实验方面还是临床方面，都是一种有用的诊断工具。
