Portaluppi F, Montanari L, Massari M, Di Chiara V, Capanna M
Clinica Medica, Università di Ferrara, Italy.
Am J Hypertens. 1991 Jan;4(1 Pt 1):20-6. doi: 10.1093/ajh/4.1.20.
The aim of this study was to assess the blood pressure profile of chronic renal failure in comparison with essential hypertension. Thirty hypertensive patients with chronic renal failure due to non-vascular nephropathies were matched by age, sex, and mean 24 h blood pressure, with 30 patients affected by uncomplicated mild-to-moderate essential hypertension. They were studied in an open hospital ward. Diet, meal times, sleep times, and activity schedules were standardized. Noninvasive, automatic, blood pressure recordings were performed for 48 h at sampling intervals of 15 min. The mean 24 h blood pressure almost coincided in the two groups. However, in essential hypertension a mean (+/- SD) nocturnal fall of systolic and diastolic blood pressure was found (12.7 +/- 3.8 and 12.9 +/- 4.8 mm Hg, respectively), while renal patients displayed an average nocturnal increase of 2.7 +/- 8.9 mm Hg and 3.7 +/- 7.8 (P less than .001). The renal patients had also higher heart rates, with a significantly blunted nocturnal fall (4.4 +/- 4.5 beats/min as compared to 9.3 +/- 3.1 beats/min of essential hypertension; P less than .001). Among the renal patients, the day-night blood pressure changes showed no significant correlation with age, creatinine clearance, hematocrit, nocturnal change in heart rate, or day or night mean blood pressure levels. These data suggest that an abnormal day-night pattern of blood pressure is present in chronic renal failure patients independently from external interfering factors. Hence, casual measurements of blood pressure confined to daytime may underestimate a hypertensive condition associated with chronic renal failure.
本研究旨在评估慢性肾衰竭患者与原发性高血压患者的血压状况。选取30例因非血管性肾病导致慢性肾衰竭的高血压患者，按照年龄、性别和24小时平均血压与30例无并发症的轻至中度原发性高血压患者进行匹配。他们在开放的医院病房接受研究。饮食、用餐时间、睡眠时间和活动安排均标准化。以15分钟为采样间隔进行48小时的无创自动血压记录。两组的24小时平均血压几乎一致。然而，原发性高血压患者收缩压和舒张压的夜间平均下降幅度（分别为12.7±3.8和12.9±4.8 mmHg），而肾衰竭患者夜间平均升高2.7±8.9 mmHg和3.7±7.8 mmHg（P＜0.001）。肾衰竭患者的心率也较高，夜间下降明显减弱（4.4±4.5次/分钟，而原发性高血压患者为9.3±3.1次/分钟；P＜0.001）。在肾衰竭患者中，昼夜血压变化与年龄、肌酐清除率、血细胞比容、夜间心率变化或昼夜平均血压水平均无显著相关性。这些数据表明，慢性肾衰竭患者存在异常的昼夜血压模式，独立于外部干扰因素。因此，仅在白天进行的偶然血压测量可能会低估与慢性肾衰竭相关的高血压状况。
