Zullig Leah L, Diamantidis Clarissa J, Bosworth Hayden B, Bhapkar Manjushri V, Barnhart Huiman, Oakes Megan M, Pendergast Jane F, Miller Julie J, Patel Uptal D
Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Health Care Center, Durham, NC, USA.
Division of General Internal Medicine, Duke University, Durham, NC, USA.
J Clin Hypertens (Greenwich). 2017 Dec;19(12):1327-1335. doi: 10.1111/jch.13088. Epub 2017 Aug 20.
While racial variation in ambulatory blood pressure (BP) is known, patterns of diurnal dipping in the context of diabetic kidney disease have not been well defined. The authors sought to determine the association of race with nocturnal dipping status among participants with diabetic kidney disease enrolled in the STOP-DKD (Simultaneous Risk Factor Control Using Telehealth to Slow Progression of Diabetic Kidney Disease) trial. The primary outcome was nocturnal dipping-percent decrease in average systolic BP from wake to sleep-with categories defined as reverse dippers (decrease <0%), nondippers (0%-<10%), and dippers (≥10%). Twenty-four-hour ambulatory BP monitoring was completed by 108 participants (54% were nondippers, 24% were dippers, and 22% were reverse dippers). In adjusted models, the common odds of reverse dippers vs nondippers/dippers and reverse dippers/nondippers vs dippers was 2.6 (95% confidence interval, 1.2-5.8) times higher in blacks than in whites. Without ambulatory BP monitoring data, interventions that target BP in black patients may be unable to improve outcomes in this high-risk group.
虽然已知动态血压（BP）存在种族差异，但糖尿病肾病患者的昼夜血压下降模式尚未明确界定。作者试图在参与STOP-DKD（利用远程医疗同时控制危险因素以减缓糖尿病肾病进展）试验的糖尿病肾病患者中，确定种族与夜间血压下降状态之间的关联。主要结局是夜间血压下降——平均收缩压从清醒到睡眠的下降百分比——分为反勺型（下降<0%）、非勺型（0%-<10%）和勺型（≥10%）。108名参与者完成了24小时动态血压监测（54%为非勺型，24%为勺型，22%为反勺型）。在调整模型中，黑人中反勺型与非勺型/勺型以及反勺型/非勺型与勺型相比的共同比值比是白人的2.6倍（95%置信区间，1.2-5.8）。如果没有动态血压监测数据，针对黑人患者血压的干预措施可能无法改善这一高危人群的结局。
