调整抗高血压治疗时间以降低慢性肾脏病患者的夜间血压：一项为期8周的非对照试验。

Changing the timing of antihypertensive therapy to reduce nocturnal blood pressure in CKD: an 8-week uncontrolled trial.

作者信息

Minutolo Roberto, Gabbai Francis B, Borrelli Silvio, Scigliano Raffaele, Trucillo Paolo, Baldanza Diego, Laurino Simona, Mascia Sara, Conte Giuseppe, De Nicola Luca

机构信息

Department of Nephrology, Second University of Naples, Naples, Italy.

出版信息

Am J Kidney Dis. 2007 Dec;50(6):908-17. doi: 10.1053/j.ajkd.2007.07.020.

DOI:10.1053/j.ajkd.2007.07.020

PMID:18037091

Abstract

BACKGROUND

Nondipping status is associated with greater cardiovascular morbidity and mortality and faster progression of chronic kidney disease (CKD). We examined whether shifting 1 antihypertensive drug from morning to evening restores the circadian rhythm of blood pressure in nondipper patients with CKD.

STUDY DESIGN

8-week clinical trial without a control group.

SETTING & PARTICIPANTS: We selected from our outpatient renal clinic 32 patients with CKD with estimated glomerular filtration rate less than 90 mL/min/1.73 m(2) and night-day ratio of mean ambulatory blood pressure (ABP) greater than 0.9, but with normal daytime ABP (<135/85 mm Hg) to avoid the required therapy intensification.

INTERVENTION

Shifting 1 antihypertensive drug from morning to evening.

OUTCOMES

Percentage of patients changing the night-day ratio of mean ABP from greater than 0.9 to 0.9 or less 8 weeks after the shift.

MEASUREMENTS

Office blood pressure/ABP and proteinuria at baseline and after the shift.

RESULTS

There were 55% men with a mean age of 67.4 +/- 11.3 years and estimated glomerular filtration rate of 46 +/- 12 mL/min/1.73 m(2). They were treated with 2.4 +/- 1.4 antihypertensive drugs. After the drug shift, the night-day ratio of mean ABP decreased in 93.7% of patients, with normal circadian rhythm restored in 87.5%. The nocturnal systolic and diastolic ABP decrease was not associated with an increase in diurnal ABP and was independent from number and class of shifted drug. Office blood pressure in the morning also decreased (from 136 +/- 16/77 +/- 10 to 131 +/- 13/75 +/- 8 mm Hg; P = 0.02). Urinary protein excretion decreased from 235 +/- 259 to 167 +/- 206 mg/d (P < 0.001).

LIMITATIONS

Absence of a control group and patients with severe proteinuria or uncontrolled daytime ABP.

CONCLUSIONS

In nondipper patients with CKD, changing the timing of antihypertensive therapy decreases nocturnal blood pressure and proteinuria.

摘要

背景

血压非勺型状态与更高的心血管发病率和死亡率以及慢性肾脏病（CKD）的更快进展相关。我们研究了将一种降压药物从早晨服用改为晚上服用是否能恢复CKD非勺型患者的血压昼夜节律。

研究设计

一项无对照组的8周临床试验。

设置与参与者

我们从门诊肾脏科选取了32例CKD患者，其估算肾小球滤过率低于90 mL/min/1.73 m²，平均动态血压（ABP）的夜间与日间比值大于0.9，但日间ABP正常（<135/85 mmHg），以避免需要强化治疗。

干预措施

将一种降压药物从早晨服用改为晚上服用。

结果

在药物服用时间改变8周后，平均ABP夜间与日间比值从大于0.9降至0.9或更低的患者百分比。

测量指标

基线及药物服用时间改变后的诊室血压/ABP和蛋白尿。

结果

男性占55%，平均年龄为67.4±11.3岁，估算肾小球滤过率为46±12 mL/min/1.73 m²。他们接受2.4±1.4种降压药物治疗。药物服用时间改变后，93.7%的患者平均ABP夜间与日间比值下降，87.5%的患者恢复了正常昼夜节律。夜间收缩压和舒张压ABP的下降与日间ABP的升高无关，且与所改变药物的数量和类别无关。早晨的诊室血压也有所下降（从136±16/77±10降至131±13/75±8 mmHg；P = 0.02）。尿蛋白排泄量从235±259降至167±206 mg/d（P < 0.001）。