Xu Hong, Huang Xiaoyan, Risérus Ulf, Cederholm Tommy, Sjögren Per, Lindholm Bengt, Ärnlöv Johan, Carrero Juan Jesús
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden.
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden ; Division of Nephrology , Peking University Shenzhen Hospital , Shenzhen , China.
Clin Kidney J. 2015 Oct;8(5):560-6. doi: 10.1093/ckj/sfv068. Epub 2015 Aug 4.
Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects. We investigated associations and interactions of these two risk factors with circadian BP rhythm variation and non-dipper pattern progression in community-dwelling older men.
This was a cross-sectional and longitudinal analyses in the third and fourth cycles of the Uppsala Longitudinal Study of Adult Men, including 1051 men (age 71 years) with assessments on urinary albumin excretion rate (UAER), 24-h ambulatory BP monitoring (ABPM) and cystatin-C-estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years. Study outcomes were ABMP changes and non-dipping BP pattern (prevalence and progression).
UAER associated with circadian BP rhythm both cross-sectionally and longitudinally. Longitudinally, significant interactions were observed between UAER and kidney dysfunction (eGFR < 60 mL/min/1.73 m(2)) in its association with the changes of both night-time systolic BP (SBP) and night-day SBP ratio. After stratification, UAER strongly predicted night-day SBP ratio change only in those with concurrent kidney dysfunction. At re-examination, 221 new cases of non-dipper were identified. In multivariable logistic models, high UAER associated with increased likelihood of non-dipper progression, but more strongly so among individuals with concurrent kidney dysfunction. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER.
UAER associates with circadian BP rhythm variation and non-dipper progression in elderly men. Concurrent renal dysfunction modifies and exacerbates these associations.
蛋白尿和肾功能不全均可能影响昼夜血压（BP）节律，且二者的影响会相互加剧。我们调查了这两种危险因素与社区老年男性昼夜血压节律变化及非勺型血压模式进展之间的关联和相互作用。
这是对乌普萨拉成年男性纵向研究第三和第四轮的横断面和纵向分析，纳入了1051名男性（年龄71岁），对其进行尿白蛋白排泄率（UAER）、24小时动态血压监测（ABPM）以及胱抑素C估算的肾小球滤过率（eGFR）评估。其中，574名男性在6年后参加了复查。研究结局为ABMP变化和非勺型血压模式（患病率和进展情况）。
UAER在横断面和纵向均与昼夜血压节律相关。纵向来看，在UAER与肾功能不全（eGFR<60 mL/min/1.73 m²）关联于夜间收缩压（SBP）和夜间-日间SBP比值变化方面，观察到显著的相互作用。分层后，UAER仅在合并肾功能不全的人群中强烈预测夜间-日间SBP比值变化。复查时，确定了221例新的非勺型血压病例。在多变量逻辑模型中，高UAER与非勺型血压模式进展可能性增加相关，但在合并肾功能不全的个体中相关性更强。这些关联在非糖尿病亚组和UAER在正常范围内的参与者中也很明显。
UAER与老年男性昼夜血压节律变化及非勺型血压模式进展相关。同时存在的肾功能不全可改变并加剧这些关联。
