Kolonko Aureliusz, Bartmańska Magdalena, Słabiak-Błaż Natalia, Kuczera Piotr, Kujawa-Szewieczek Agata, Ficek Rafał, Owczarek Aleksander J, Chudek Jerzy, Więcek Andrzej
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia Department of Statistics, Department of Instrumental Analysis, School of Pharmacy With the Division of Laboratory Medicine in Sosnowiec Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland.
Medicine (Baltimore). 2018 Sep;97(36):e11870. doi: 10.1097/MD.0000000000011870.
Vascular injury related to chronic kidney disease results in increased arterial stiffness and endothelial dysfunction which may affect arterial blood pressure (BP) and influence patient and graft survival in kidney transplant recipients (KTRs).This cross-sectional study aims to elucidate the relationship between the above-mentioned measures of vascular damage and effectiveness of antihypertensive treatment in KTR.One hundred forty-five KTRs 7.6 ± 2.7 years after transplantation were enrolled in our study. Pulse wave velocity (PWV), flow-mediated dilation (FMD), and nitroglycerin-mediated dilation (NMD) were measured, and 24-hour ambulatory BP monitoring was performed.Overall, there were 62 patients with well-controlled or borderline BP and 83 subjects who did not achieve target BP despite antihypertensive treatment. Patients with suboptimal BP control were characterized by greater PWV (median 9.6/interquartile range: 3.9 vs 8.0/3.3 m/s, P = .002), but borderline lower FMD (8.4% ± 5.0% vs 9.9% ± 5.7%; P = .09) as compared with the group with better BP control. When patients were allocated to subgroups based on the number of current antihypertensive medications, no differences in FMD and NMD were found. However, a significant trend was observed for higher PWV values and decreased proportion of dippers along with the increasing number of drugs. PWV, diabetes, and total cholesterol level, but not FMD or NMD, were explanatory variables for systolic BP in multivariate analysis.Arterial stiffness but not endothelial dysfunction is associated with suboptimal BP control in stable KTRs. Less efficient antihypertensive treatment appears to be caused by inadequate control of nocturnal BP.
与慢性肾脏病相关的血管损伤会导致动脉僵硬度增加和内皮功能障碍，这可能会影响动脉血压（BP），并影响肾移植受者（KTRs）的患者及移植物存活。这项横断面研究旨在阐明上述血管损伤指标与KTRs降压治疗效果之间的关系。145名移植后7.6±2.7年的KTRs纳入我们的研究。测量脉搏波速度（PWV）、血流介导的舒张功能（FMD）和硝酸甘油介导的舒张功能（NMD），并进行24小时动态血压监测。总体而言，有62例患者血压控制良好或处于临界状态，83例患者尽管接受了降压治疗仍未达到目标血压。血压控制欠佳的患者的特征是PWV更高（中位数9.6/四分位间距：3.9 vs 8.0/3.3m/s，P = 0.002），但与血压控制较好的组相比，FMD略低（8.4%±5.0% vs 9.9%±5.7%；P = 0.09）。当根据当前降压药物的数量将患者分为亚组时，未发现FMD和NMD有差异。然而，随着药物数量的增加，观察到PWV值升高和杓型血压比例降低的显著趋势。在多变量分析中，PWV、糖尿病和总胆固醇水平而非FMD或NMD是收缩压的解释变量。在稳定的KTRs中，动脉僵硬度而非内皮功能障碍与血压控制欠佳相关。降压治疗效果欠佳似乎是由于夜间血压控制不足所致。
