Li Yan, Deng Qiongxia, Li Huiqun, Ma Xinxin, Zhang Jun, Peng Hui, Wang Cheng, Lou Tanqi
Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of Pathology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
J Clin Hypertens (Greenwich). 2017 Sep;19(9):890-898. doi: 10.1111/jch.13017. Epub 2017 May 7.
The prognostic value of nighttime blood pressure (BP) load in patients with chronic kidney disease (CKD) remains unknown. The prognostic value of nighttime BP load in a cohort of Chinese patients with nondialysis CKD was investigated. The authors monitored ambulatory BP and followed health outcomes in 588 Chinese CKD patients. Multivariable-adjusted Cox regression analyses indicated that nighttime BP load was a significant risk factor for all clinical outcomes in CKD patients, even when adjusted for clinic BP. Tertile 3 of systolic BP load (vs tertile 1) was associated with an increased risk of renal events (hazard ratio [HR], 2.21; 95% confidence interval [CI], 1.12-4.38) and cardiovascular events (HR, 5.34; 95% CI, 1.58-18.04); tertile 3 of diastolic BP load (vs tertile 1) was associated with an increased risk of all-cause mortality (HR, 6.73; 95% CI, 1.79-25.20), cardiovascular mortality (HR, 7.18; 95% CI, 1.47-35.03), renal events (HR, 2.40; 95% CI, 1.17-4.92), and cardiovascular events (HR, 5.87; 95% CI, 1.97-17.52). Higher nighttime BP load, especially nighttime diastolic BP load, was associated with a poorer prognosis in Chinese nondialysis CKD patients.
慢性肾脏病（CKD）患者夜间血压（BP）负荷的预后价值尚不清楚。本研究调查了中国非透析CKD患者队列中夜间BP负荷的预后价值。作者对588例中国CKD患者进行了动态血压监测并随访其健康结局。多变量调整的Cox回归分析表明，夜间BP负荷是CKD患者所有临床结局的重要危险因素，即使在调整了诊室血压后亦是如此。收缩压负荷三分位数3（与三分位数1相比）与肾脏事件风险增加相关（风险比[HR]，2.21；95%置信区间[CI]，1.12 - 4.38）以及心血管事件风险增加相关（HR，5.34；95% CI，1.58 - 18.04）；舒张压负荷三分位数3（与三分位数1相比）与全因死亡率风险增加相关（HR，6.73；95% CI，1.79 - 25.20）、心血管死亡率风险增加相关（HR，7.18；95% CI，1.47 - 35.03）、肾脏事件风险增加相关（HR，2.40；95% CI，1.17 - 4.92）以及心血管事件风险增加相关（HR，5.87；95% CI，1.97 - 17.52）。较高的夜间BP负荷，尤其是夜间舒张压负荷，与中国非透析CKD患者较差的预后相关。
