Wadei Hani M, Amer Hatem, Taler Sandra J, Cosio Fernando G, Griffin Matthew D, Grande Joseph P, Larson Timothy S, Schwab Thomas R, Stegall Mark D, Textor Stephen C
Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
J Am Soc Nephrol. 2007 May;18(5):1607-15. doi: 10.1681/ASN.2006111289. Epub 2007 Apr 4.
Loss of circadian BP change has been linked to target organ damage and accelerated kidney function loss in hypertensive patients with and without chronic kidney disease. Ambulatory BP-derived data from 119 consecutive kidney transplant recipients who presented for the first annual evaluation were examined in relation to allograft function, histology, and ultrasound findings. A total of 101 (85%) patients were receiving antihypertensive medications (median 2), and 85 (71%) achieved target awake average systolic BP (SBP) of <135 mmHg. A day-night change in SBP by 10% or more (dippers) was detected in 29 (24%). Dipping status was associated with younger recipient age, lack of diabetes, low chronic vascular score, and low resistive index. Nondippers and reverse dippers had lower GFR compared with dippers (P = 0.04). For every 10% nocturnal drop in SBP, GFR increased by 4.6 ml/min per 1.73 m(2) (R = 0.3, P = 0.003). Nondippers and reverse dippers were equally common in recipients with normal histology and in those with pathologic findings on surveillance biopsy. On multivariate analysis, percentage of nocturnal fall in SBP and elevated resistive index independently correlated with GFR. This study indicates that lack of nocturnal fall in SBP is related to poor allograft function, high chronic vascular score, and high resistive index irrespective of allograft fibrosis. Further studies are needed to determine whether restoration of normal BP pattern will confer better allograft outcome.
昼夜血压变化消失与患有和未患有慢性肾脏病的高血压患者的靶器官损害及肾功能加速丧失有关。对119例前来进行首次年度评估的连续肾移植受者的动态血压衍生数据进行了检查，分析其与移植肾功能、组织学及超声检查结果的关系。共有101例（85%）患者正在接受抗高血压药物治疗（中位数为2种），85例（71%）患者达到清醒时平均收缩压（SBP）<135 mmHg的目标值。29例（24%）患者检测到SBP昼夜变化≥10%（杓型）。杓型状态与受者年龄较轻、无糖尿病、慢性血管评分低及阻力指数低有关。与杓型患者相比，非杓型和反杓型患者的肾小球滤过率（GFR）较低（P = 0.04）。SBP每夜间下降10%，GFR每1.73 m²增加4.6 ml/min（R = 0.3，P = 0.003）。在组织学正常和监测活检有病理发现的受者中，非杓型和反杓型同样常见。多因素分析显示，SBP夜间下降百分比和阻力指数升高与GFR独立相关。本研究表明，SBP夜间下降不足与移植肾功能差、慢性血管评分高及阻力指数高有关，与移植肾纤维化无关。需要进一步研究以确定恢复正常血压模式是否会带来更好的移植肾结局。
