Department of Internal Medicine, St Elizabeth Health Center, Youngstown, OH, USA.
J Clin Hypertens (Greenwich). 2012 Sep;14(9):611-7. doi: 10.1111/j.1751-7176.2012.00675.x. Epub 2012 Jun 20.
The role of ambulatory blood pressure (BP) monitoring (ABPM) has not been well-studied in patients with chronic kidney disease and resistant hypertension. In a retrospective study of the outpatient chronic kidney disease population, 156 patients with chronic kidney disease and resistant hypertension who had 24-hour ABPM and clinic BP measurements were identified. Resistant hypertension was defined as uncontrolled clinic BP while taking ≥ 3 medications including a diuretic or controlled BP while taking ≥ 4 medications. Within the study group, ambulatory BP <130/80 mm Hg was found in 35.9% of all patients. Only 6.4% had both ambulatory and clinic BP <130/80 mm Hg. Prevalence of white-coat hypertension, masked hypertension, and sustained hypertension were 29.5%, 5.8%, and 58.3%, respectively. Compared with patients with sustained hypertension, more patients in the white-coat hypertension group had low nocturnal average systolic BP (defined as nocturnal average systolic BP <100 mm Hg) (17.4% vs 0%) and low 24-hour average diastolic BP (defined as 24-hour average diastolic BP <60 mm Hg) (52.2% vs 22%, P<.01). ABPM provides more reliable assessment of BP in patients with chronic kidney disease and resistant hypertension.
动态血压监测（ABPM）在慢性肾脏病和难治性高血压患者中的作用尚未得到充分研究。在一项对门诊慢性肾脏病患者的回顾性研究中，确定了 156 名患有慢性肾脏病和难治性高血压的患者，这些患者进行了 24 小时 ABPM 和诊所血压测量。难治性高血压定义为在服用≥3 种药物（包括利尿剂）时未控制的诊所血压，或在服用≥4 种药物时控制的血压。在研究组中，所有患者中有 35.9%的患者的动态血压<130/80mmHg。仅 6.4%的患者同时具有<130/80mmHg 的动态和诊所血压。白大衣高血压、隐匿性高血压和持续性高血压的患病率分别为 29.5%、5.8%和 58.3%。与持续性高血压患者相比，白大衣高血压组中更多的患者夜间平均收缩压较低（定义为夜间平均收缩压<100mmHg）（17.4%比 0%）和 24 小时平均舒张压较低（定义为 24 小时平均舒张压<60mmHg）（52.2%比 22%，P<.01）。ABPM 为慢性肾脏病和难治性高血压患者的血压提供了更可靠的评估。
