Velasquez Manuel T, Beddhu Srinivasan, Nobakht Ehsan, Rahman Mahboob, Raj Dominic S
Division of Renal Diseases and Hypertension, The George Washington University, Washington, DC, USA.
University of Utah School of Medicine, Kidney and Liver Clinic, Salt Lake City, Utah, USA.
Kidney Int Rep. 2016 Jul;1(2):94-104. doi: 10.1016/j.ekir.2016.05.001. Epub 2016 Jun 4.
Hypertension is common in patients with chronic kidney disease (CKD) and is the most important modifiable risk factor for CKD progression and adverse cardiovascular events in these patients. Diagnosis and successful management of hypertension are critically dependent on accurate blood pressure (BP) measurement. This is most relevant to CKD patients, in whom BP control is difficult to achieve and in whom early antihypertensive treatment is imperative to prevent kidney and cardiovascular complications. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting hypertension than office BP measurement. ABPM is also a superior prognostic marker compared with office BP and has successfully identified hypertensive CKD patients at increased risk. Additionally, ABPM provides information on circadian BP variation and short-term BP variability, which is associated with cardiovascular and renal outcomes. This paper reviews the evidence for the usefulness of ABPM in detection and management of hypertension in CKD patients and discusses our current understanding of the pathophysiology of altered circadian BP rhythm and variability in CKD and the role of abnormal BP patterns detected by ABPM in relation to outcomes in CKD. In addition, this Review examines the emerging role of antihypertensive chronotherapy to tailor BP management to the circadian BP pattern abnormality detected by 24-hour ABPM.
高血压在慢性肾脏病（CKD）患者中很常见，并且是这些患者CKD进展及不良心血管事件的最重要可改变危险因素。高血压的诊断和成功管理严重依赖于准确的血压（BP）测量。这对于CKD患者最为重要，因为他们难以实现血压控制，且早期抗高血压治疗对于预防肾脏和心血管并发症至关重要。累积数据表明，动态血压监测（ABPM）在检测高血压方面比诊室血压测量更具优势。与诊室血压相比，ABPM也是一种更优的预后标志物，并且已成功识别出风险增加的高血压CKD患者。此外，ABPM可提供有关昼夜血压变化和短期血压变异性的信息，这与心血管和肾脏结局相关。本文综述了ABPM在CKD患者高血压检测和管理中的有用性证据，并讨论了我们目前对CKD患者昼夜血压节律改变和变异性的病理生理学的理解，以及ABPM检测到的异常血压模式与CKD结局的关系。此外，本综述探讨了抗高血压时辰疗法在根据24小时ABPM检测到的昼夜血压模式异常调整血压管理方面的新作用。
