24小时动态血压监测中的非勺型模式与慢性肾脏病患者的左心室肥厚相关。

Nondipping pattern on 24-h ambulatory blood pressure monitoring is associated with left ventricular hypertrophy in chronic kidney disease.

作者信息

Jaques David A, Müller Hajo, Martinez Chantal, De Seigneux Sophie, Martin Pierre-Yves, Ponte Belen, Saudan Patrick

机构信息

Divisions of General Internal Medicine.

Cardiology.

出版信息

Blood Press Monit. 2018 Oct;23(5):244-252. doi: 10.1097/MBP.0000000000000337.

DOI:10.1097/MBP.0000000000000337

PMID:29958233

Abstract

BACKGROUND

Few studies have assessed the role of 24-h ambulatory blood pressure monitoring (ABPM) in adults with nondialysis chronic kidney disease (CKD). We examined the potential determinants of left ventricular hypertrophy (LVH) and mass index (LVMI) in this population.

PARTICIPANTS AND METHODS

We carried out a cross-sectional study on 69 stage 3b-5 CKD adults who had ABPM and transthoracic echocardiography performed simultaneously. Hypertension (HT) was defined as 24 h blood pressure (BP) of at least 130/80 mmHg. ABPM parameters considered were BP dipping status, BP load, and the BP night-time/daytime ratio. We performed stepwise backward multivariate linear and logistic regression to assess the determinants of LVH and LVMI. ABPM parameters were considered the main independent variables, whereas HT, angiotensin-converting enzyme inhibitor/angiotensin II receptor antagonist use, glomerular filtration rate of less than 30 ml/min/1.72 m, diabetes, smoking, age, sex, hemoglobin, and parathyroid hormone levels were considered covariates.

RESULTS

LVH was present in 22 (31.8%) patients. In linear regression analysis, systolic [β=-13.8, 95% confidence interval (CI)=-26.3 to -1.3, P=0.031] and mean (β=-13.5, 95% CI=-25.7 to -1.2, P=0.031) nondipping status was associated with increased LVMI. BP load and night-time/daytime ABPM ratio were not associated with LVMI. In logistic regression analysis, systolic nondipping status (odds ratio=0.27, 95% CI=0.08-0.91, P=0.036) was associated with LVH. Among covariates, estimated glomerular filtration rate of less than 30 ml/min/1.72 m and HT were associated with LVH and increased LVMI. At 1-year follow-up, mean nondipping status on the initial ABPM remained associated significantly with increased LVMI (β=-19.8, 95% CI=-36.6 to -3.0, P=0.022).

CONCLUSION

These data confirm the high incidence of LVH among nonrenal replacement therapy CKD patients and suggest that the nondipping phenomenon on ABPM is associated independently with LVH and increased LVMI in this population.

摘要

背景

很少有研究评估24小时动态血压监测（ABPM）在非透析慢性肾脏病（CKD）成人患者中的作用。我们研究了该人群左心室肥厚（LVH）和质量指数（LVMI）的潜在决定因素。

参与者和方法

我们对69例3b - 5期CKD成人患者进行了一项横断面研究，这些患者同时进行了ABPM和经胸超声心动图检查。高血压（HT）定义为24小时血压（BP）至少为130/80 mmHg。所考虑的ABPM参数包括血压昼夜节律状态、血压负荷以及血压夜间/日间比值。我们进行逐步向后多变量线性和逻辑回归分析，以评估LVH和LVMI的决定因素。ABPM参数被视为主要自变量，而HT、血管紧张素转换酶抑制剂/血管紧张素II受体拮抗剂的使用、肾小球滤过率低于30 ml/min/1.72 m²、糖尿病、吸烟、年龄、性别、血红蛋白和甲状旁腺激素水平被视为协变量。

结果

22例（31.8%）患者存在LVH。在线性回归分析中，收缩压[β=-13.8，95%置信区间（CI）=-26.3至-1.3，P=0.031]和平均压（β=-13.5，95% CI=-25.7至-1.2，P=0.031）的非勺型状态与LVMI升高相关。血压负荷和夜间/日间ABPM比值与LVMI无关。在逻辑回归分析中，收缩压非勺型状态（比值比=0.27，95% CI=0.08 - 0.91，P=0.036）与LVH相关。在协变量中，估计肾小球滤过率低于30 ml/min/1.72 m²和HT与LVH及LVMI升高相关。在1年随访中，初始ABPM时的平均非勺型状态仍与LVMI升高显著相关（β=-19.8，95% CI=-36.6至-3.0，P=0.022）。