Nakai Kentaro, Fujii Hideki, Watanabe Kentaro, Watanabe Shuhei, Awata Rie, Kono Keiji, Yonekura Yuriko, Goto Shunsuke, Nishi Shinichi
a Division of Nephrology and Kidney Center , Kobe University Graduate School of Medicine , Kobe , Japan.
Clin Exp Hypertens. 2016;38(5):476-81. doi: 10.3109/10641963.2016.1163368. Epub 2016 Jul 1.
Hypertension is a crucial risk factor for cardiovascular death and loss of residual kidney function. Absence of the nocturnal decline in blood pressure (BP) predicts cardiovascular events and poor prognosis. However, characteristics of hypertension in moderate-to-severe chronic kidney disease (CKD) have not been fully evaluated. We aimed to assess the circadian variation of BP and kidney survival in CKD patients.
Patients who were examined by 24-h ambulatory BP monitoring (ABPM) and estimated glomerular filtration rate (eGFR), <45 ml/min/1.73 m(2), were enrolled in the study. The impacts of BP circadian rhythm and brain natriuretic peptide (BNP) on kidney survival were evaluated.
A total of 124 patients were enrolled. The average age was 64 ± 14 years, 57% were male, and 43% had diabetes. Forty-five percent of patients had a non-dipper pattern, 35% had a riser pattern, 19% had a dipper pattern, and 1% had an extreme-dipper pattern. The prevalence of diabetes and plasma BNP levels was higher and eGFR was lower in the riser-pattern group than in the non-riser-pattern group. Kidney survival rates were significantly worse in the riser-pattern group than in the non-riser-pattern group (p < 0.05). Moreover, among riser and non-riser pattern groups divided by BNP levels, the riser group with higher BNP level showed the worst kidney survival (p < 0.05).
The riser pattern is frequently associated with several conditions at higher risk for kidney survival. Patients with a rising pattern and higher BNP levels have a worse kidney prognosis.
高血压是心血管死亡和残余肾功能丧失的关键危险因素。夜间血压（BP）无下降可预测心血管事件和不良预后。然而，中重度慢性肾脏病（CKD）患者高血压的特征尚未得到充分评估。我们旨在评估CKD患者血压的昼夜变化和肾脏生存率。
通过24小时动态血压监测（ABPM）和估算肾小球滤过率（eGFR）<45 ml/min/1.73 m²检查的患者纳入本研究。评估血压昼夜节律和脑钠肽（BNP）对肾脏生存的影响。
共纳入124例患者。平均年龄为64±14岁，57%为男性，43%患有糖尿病。45%的患者为非勺型模式，35%为上升型模式，19%为勺型模式，1%为极端勺型模式。上升型模式组的糖尿病患病率和血浆BNP水平高于非上升型模式组，而eGFR低于非上升型模式组。上升型模式组的肾脏生存率显著低于非上升型模式组（p<0.05）。此外，在按BNP水平划分的上升型和非上升型模式组中，BNP水平较高的上升型组肾脏生存率最差（p<0.05）。
上升型模式常与肾脏生存风险较高的几种情况相关。上升型模式且BNP水平较高的患者肾脏预后较差。
