Division of Nephrology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
J Clin Hypertens (Greenwich). 2013 Jan;15(1):48-54. doi: 10.1111/jch.12021. Epub 2012 Oct 9.
Nondipping blood pressure (BP) pattern is a potential independent risk factor for chronic kidney disease (CKD). Bedtime administration of valsartan is considered to normalize circadian rhythm and protect the kidneys and heart in CKD patients. However, more clinical trials are needed to confirm this benefit. Sixty patients with nondipping BP pattern and thirty patients with dipping BP pattern were enrolled in this study, and the patients with nondipping BP pattern were randomly divided into two groups and treated with bedtime or awakening doses of valsartan (80-320 mg). Nondipping BP patients treated with bedtime doses of valsartan showed a greater reduction in 24-hour proteinuria and bedtime proteinuria, a greater delayed decline in estimated glomerular filtration rate, and more protection against myocardial hypertrophy (P<.05) compared with patients with the nondipping BP pattern treated with the awakening dose (P<.05). This was similar to patients with dipping BP. No severe clinical complications were recorded in these patients. Valsartan with bedtime dosing in CKD patients with the nondipping BP pattern have better renal and cardiovascular protection. Antihypertensive "chronotherapy" may be useful in clinical practice for CKD patients.
非杓型血压（BP）模式是慢性肾脏病（CKD）的一个潜在独立危险因素。缬沙坦在睡前给药被认为可以使昼夜节律正常化，并在 CKD 患者中保护肾脏和心脏。然而，还需要更多的临床试验来证实这一益处。本研究纳入了 60 例非杓型血压患者和 30 例杓型血压患者，将非杓型血压患者随机分为两组，分别给予睡前或觉醒剂量的缬沙坦（80-320mg）治疗。与接受觉醒剂量缬沙坦治疗的非杓型血压患者相比，接受睡前剂量缬沙坦治疗的非杓型血压患者 24 小时蛋白尿和睡前蛋白尿降低更明显，估算肾小球滤过率下降更延迟，心肌肥厚的保护作用更大（P<.05）。这与杓型血压患者相似。这些患者均未记录到严重的临床并发症。对于非杓型血压的 CKD 患者，缬沙坦睡前给药具有更好的肾脏和心血管保护作用。降压“时间治疗学”可能对 CKD 患者的临床实践有用。
