a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan.
b Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School , Singapore.
Clin Exp Hypertens. 2017;39(7):665-671. doi: 10.1080/10641963.2017.1313850. Epub 2017 Jun 21.
As there may be an association between within-visit blood pressure (BP) variability and cardiovascular disease (CVD), we investigated the clinical significance of this BP variability in non-dialysis chronic kidney disease (CKD) patients.
According to the median of coefficient of variation (CV) of three systolic BP (SBP) readings within a single visit, we divided hypertensive patients with stage G1-4 CKD already treated with antihypertensive therapy into the high SBP-CV group and the low SBP-CV group. Univariate and multivariate linear regression analyses were also performed to explore the contributing factors to within-visit BP variability.
In the high SBP-CV group, the clinic BP, total cholesterol level, dyslipidemia, and past history of CVD were significantly greater, while α-blockers and renin-angiotensin system (RAS) inhibitors usage were significantly reduced compared with the lower SBP-CV group. Within-visit BP variability was significantly and positively correlated with total cholesterol (R = 0.392, P < 0.001) and low-density lipoprotein cholesterol (R = 0.284, P = 0.013). Total cholesterol (β = 0.269, P = 0.024), α-blockers usage (β = -0.260, P = 0.015), and RAS inhibitors usage (β = -0.266, P = 0.017) were shown to independently contribute to the within-visit BP variability after adjustment for age, sex, presence of diabetes, CVD history, statins usage, and clinic SBP.
We show that within-visit BP variability may be a clinically relevant factor of CVD risk, and lipid lowering and/or anti-hypertensive therapies using RAS inhibitors and α-blockers may be associated with the improved within-visit BP variability observed in non-dialysis CKD patients.
由于单次就诊内血压（BP）变异性与心血管疾病（CVD）之间可能存在关联，我们研究了这种 BP 变异性在非透析慢性肾脏病（CKD）患者中的临床意义。
根据单次就诊内三次收缩压（SBP）读数的变异系数（CV）中位数，我们将已经接受降压治疗的 G1-4 期 CKD 高血压患者分为高 SBP-CV 组和低 SBP-CV 组。还进行了单变量和多变量线性回归分析，以探讨单次就诊内 BP 变异性的影响因素。
在高 SBP-CV 组中，临床 BP、总胆固醇水平、血脂异常和 CVD 既往史显著增加，而α受体阻滞剂和肾素-血管紧张素系统（RAS）抑制剂的使用率显著降低。单次就诊内 BP 变异性与总胆固醇呈显著正相关（R = 0.392，P < 0.001）和低密度脂蛋白胆固醇（R = 0.284，P = 0.013）。总胆固醇（β = 0.269，P = 0.024）、α受体阻滞剂的使用（β = -0.260，P = 0.015）和 RAS 抑制剂的使用（β = -0.266，P = 0.017）经年龄、性别、糖尿病、CVD 史、他汀类药物使用和临床 SBP 调整后，均显示可独立影响单次就诊内 BP 变异性。
我们表明，单次就诊内 BP 变异性可能是 CVD 风险的一个临床相关因素，降低血脂和/或使用 RAS 抑制剂和α受体阻滞剂的降压治疗可能与非透析 CKD 患者观察到的单次就诊内 BP 变异性改善有关。
