Oh Se Won, Han Sang Youb, Han Kum Hyun, Cha Ran-hui, Kim Sejoong, Yoon Sun Ae, Rhu Dong-Ryeol, Oh Jieun, Lee Eun Young, Kim Dong Ki, Kim Yon Su
Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Korea.
Department of Internal Medicine, National Medical Center, Seoul, Korea.
Hypertens Res. 2015 Dec;38(12):889-94. doi: 10.1038/hr.2015.89. Epub 2015 Aug 27.
Morning hypertension (HTN) and nocturnal non-dipping (ND) are closely associated with target organ damage and cardiovascular events. However, their importance in diabetics with advanced renal disease is unclear. We evaluated the relationships of morning HTN and ND with estimated glomerular filtration rate (eGFR) and proteinuria, and determined the risk of morning HTN and ND according to presence of diabetes mellitus (DM) and chronic kidney disease (CKD) stage. A total of 1312 patients, including 439 with diabetes, were prospectively recruited at 21 centers in Korea. All patients had HTN and an eGFR of 15-89 ml min(-1) per 1.73 m(2). Ambulatory 24-h blood pressure was assessed. The rates of morning HTN (25.2% vs. 13.6%, P<0.001) and ND (58.2% vs. 48.2%, P=0.002) were higher in diabetics than in non-diabetics. eGFR was correlated with ND in all patients (P<0.05) and with morning HTN only in non-diabetics (P=0.005). Proteinuria was related to ND in all patients (P<0.05) and to morning HTN only in diabetics (P=0.001). In a regression analysis, the risk of morning HTN was 2.093 (95% confidence interval (95% CI): 1.070-4.094) for the DMCKD2 group, 1.634 (95% CI: 1.044-2.557) for the CKD3-4-only group and 2.236 (95% CI: 1.401-3.570) for the DMCKD3-4 group compared with the CKD2-only group. The risk of ND was high for stage 3-4 CKD: 1.581 (95% CI: 1.180-2.120) for non-diabetics and 1.842 (95% CI: 1.348-2.601) for diabetics. Diabetics showed higher rates of morning HTN, ND and uncontrolled sustained HTN compared with non-diabetics with CKD of the same stages.
清晨高血压（HTN）与夜间血压非勺型变化（ND）与靶器官损害及心血管事件密切相关。然而，它们在晚期肾病糖尿病患者中的重要性尚不清楚。我们评估了清晨HTN和ND与估算肾小球滤过率（eGFR）及蛋白尿的关系，并根据糖尿病（DM）和慢性肾脏病（CKD）分期确定了清晨HTN和ND的风险。在韩国的21个中心前瞻性招募了总共1312例患者，其中包括439例糖尿病患者。所有患者均患有HTN且eGFR为每1.73 m² 15 - 89 ml·min⁻¹。评估了24小时动态血压。糖尿病患者的清晨HTN发生率（25.2%对13.6%，P<0.001）和ND发生率（58.2%对48.2%，P = 0.002）高于非糖尿病患者。eGFR在所有患者中与ND相关（P<0.05），仅在非糖尿病患者中与清晨HTN相关（P = 0.005）。蛋白尿在所有患者中与ND相关（P<0.05），仅在糖尿病患者中与清晨HTN相关（P = 0.001）。在回归分析中，与仅患有CKD2期的组相比，DMCKD2组清晨HTN的风险为2.093（95%置信区间（95%CI）：1.070 - 4.094），仅患有CKD3 - 4期的组为1.634（95%CI：1.044 - 2.557），DMCKD3 - 4组为2.236（95%CI：1.401 - 3.570）。3 - 4期CKD患者ND的风险较高：非糖尿病患者为1.581（95%CI：1.180 - 2.120），糖尿病患者为1.842（95%CI：1.348 - 2.601）。与相同分期的非糖尿病CKD患者相比，糖尿病患者的清晨HTN、ND及持续性HTN未控制率更高。
