Haydar Ali A, Covic Adrian, Jayawardene Satish, Agharazii Mohsen, Smith Eilish, Gordon Isabel, O'Sullivan Helen, Goldsmith David J A
Renal and Transplantation Unit, Guy's Hospital, London, United Kingdom.
Transplantation. 2004 Mar 27;77(6):849-53. doi: 10.1097/01.tp.0000115345.16853.51.
Accurate diagnosis of hypertension is essential in chronic kidney disease patients, as it is linked to increased left ventricular mass, stroke, cardiovascular mortality and morbidity, and progression to end-stage renal disease. Elevated blood pressure (BP) detected by ambulatory BP monitoring (ABPM) has been shown to be predictive of worse outcome in chronic kidney disease patients. Another predictor of worse outcome is diurnal BP variation, measured also by ABPM. In this study, the authors examined the relationship (concordance or discordance) between blood pressure measured by ABPM compared with daytime office BP, and also explored the predictors of diurnal variation in renal transplant recipients.
All the patients who underwent renal transplantation and follow-up at the authors' institution from January 1998 to January 2003 were involved in this study (n=177) in addition to another randomly selected 64 patients that underwent transplantation before 1998. All patients had their ABPM performed according to previously described protocols at least 2 weeks after discharge from the hospital, dialysis-independent and with a functioning renal allograft.
The authors found a positive correlation between systolic BP (SBP) diurnal variation and age (r =0.263, P <0.0001), glomerular filtration rate (GFR) (r =-0.229, P <0.0001), cyclosporine trough (r =0.171, P =0.047), and ABPM-to-transplant interval (r =-0.133, P =0.039). After fitting a regression model, the authors found that only GFR (P <0.0001) and age (P =0.001) were independent predictors of SBP diurnal variation (r =0.357). Concordance rate between casual BP and ABPM was 80%, and by using casual BP, only 15% of hypertensive renal transplant patients would be erroneously diagnosed as normotensive.
The authors found that SBP diurnal variation is predicted independently by age and GFR, although it does correlate with cyclosporine trough and ABPM-to-transplant interval. In addition, the authors showed that ABPM is a more sensitive method for diagnosing hypertension than is sole reliance on office BP in renal transplant recipients.
准确诊断高血压对于慢性肾病患者至关重要，因为它与左心室质量增加、中风、心血管疾病死亡率和发病率以及进展至终末期肾病有关。动态血压监测（ABPM）检测到的血压升高已被证明可预测慢性肾病患者的不良预后。另一个不良预后的预测因素是昼夜血压变异性，也通过ABPM进行测量。在本研究中，作者研究了ABPM测量的血压与日间诊室血压之间的关系（一致性或不一致性），并探讨了肾移植受者昼夜血压变异性的预测因素。
除了另外64例在1998年之前接受移植的随机选择患者外，1998年1月至2003年1月在作者所在机构接受肾移植和随访的所有患者均参与本研究（n = 177）。所有患者在出院至少2周后，根据先前描述的方案进行ABPM，无需透析且移植肾功能良好。
作者发现收缩压（SBP）昼夜变异性与年龄（r = 0.263，P < 0.0001）、肾小球滤过率（GFR）（r = -0.229，P < 0.0001）、环孢素谷浓度（r = 0.171，P = 0.047）以及ABPM至移植间隔时间（r = -0.133，P = 0.039）呈正相关。在拟合回归模型后，作者发现只有GFR（P < 0.0001）和年龄（P = 0.001）是SBP昼夜变异性的独立预测因素（r = 0.357）。偶测血压与ABPM之间的一致性率为80%，仅使用偶测血压时，15%的高血压肾移植患者会被错误诊断为血压正常。
作者发现SBP昼夜变异性由年龄和GFR独立预测，尽管它确实与环孢素谷浓度和ABPM至移植间隔时间相关。此外，作者表明ABPM是一种比单纯依赖诊室血压更敏感的诊断肾移植受者高血压的方法。
