Sahutoglu Tuncay, Sakaci Tamer
Clin Nephrol. 2018 Jul;90(1):46-52. doi: 10.5414/CN109311.
Blood pressure variability (BPV) has been associated with increased morbidity and mortality. There are a few studies that reported worse outcomes of chronic kidney disease (CKD) with greater visit-to-visit BPV (VVV), but data with ambulatory blood pressure monitoring (ABPM) is scarce.
Ambulatory hypertensive CKD (stage 2 - 4) patients (> 18 years old) with complete 24 hours of ABPM study (SpaceLabs), who were followed up between January 2012 and December 2016, were retrospectively analyzed for the baseline characteristics and outcomes of CKD. Coefficient of variation (CV) in diastolic blood pressure (DBP) was used as an index of BPV.
Data of 191 patients (mean age 59.7 ± 12.4 years, 54.9% males, 42.1% diabetic, mean eGFR-EPI (Chronic Kidney Disease Epidemiology Collaboration) 51.7 ± 22.0 mL/min/1.73m2, mean follow-up 26.2 ± 10.4 months) were available for the analysis. On multivariate linear regression analysis, greater DBP-CV was associated with slower decline in eGFR-EPI per year (B -0.648, p = 0.000). Likewise, the hazard ratio (HR) for dialysis inception (occurred in 9.4%) was found significantly lower with increasing DBP-CV in unadjusted and fully adjusted Cox models (HR 0.730, 95% CI 0.618 - 0.861, p = 0.000, and HR 0.678, 95% CI 0.526 - 0.874, p = 0.003, respectively).
CONCLUSION: These findings suggest that DBP variability in 24-hour ABPM may be a good prognostic factor for the outcomes of CKD. Further studies are needed to determine the impact of 24-hour ABPM BPV on CKD progression and its differences from VVV. .
血压变异性（BPV）与发病率和死亡率增加相关。有一些研究报告称，随诊间血压变异性（VVV）较大的慢性肾脏病（CKD）患者预后较差，但动态血压监测（ABPM）的数据较少。
对2012年1月至2016年12月期间接受随访、有完整24小时ABPM研究（太空实验室）的非卧床高血压CKD（2 - 4期）患者（年龄>18岁）的CKD基线特征和预后进行回顾性分析。舒张压（DBP）的变异系数（CV）用作BPV指标。
191例患者的数据（平均年龄59.7±12.4岁，男性占54.9%，糖尿病患者占42.1%，平均估算肾小球滤过率-慢性肾脏病流行病学合作组（eGFR-EPI）为51.7±22.0 mL/min/1.73m²，平均随访26.2±10.4个月）可用于分析。多因素线性回归分析显示，较高的DBP-CV与每年eGFR-EPI下降较慢相关（B -0.648，p = 0.000）。同样，在未调整和完全调整的Cox模型中，随着DBP-CV增加，开始透析（发生率9.4%）的风险比（HR）显著降低（HR分别为0.730，95%CI 0.618 - 0.861，p = 0.000；以及HR 0.678，95%CI 0.526 - 0.874，p = 0.003）。
这些发现表明，24小时ABPM中的DBP变异性可能是CKD预后的良好预测因素。需要进一步研究以确定24小时ABPM BPV对CKD进展的影响及其与VVV的差异。
