Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Korean J Intern Med. 2019 Nov;34(6):1181-1187. doi: 10.3904/kjim.2019.164. Epub 2019 Jun 17.
The prevalence rates of hypertension and chronic kidney disease (CKD) are increasing with the aging of the population. Hypertension and CKD are closely related, and hypertension with accompanying CKD is difficult to control. This difficulty controlling blood pressure (BP) can be explained by changes in diurnal variation in BP, such as non-dipping and reverse dipping patterns, increased pulse pressure, and BP variability in CKD patients resulting in a high frequency of nocturnal hypertension or masked hypertension. CKD patients with uncontrolled or nocturnal hypertension are at increased risk for cardiovascular disease, progression of CKD, and all-cause death. Recent studies have shown that intensive reduction of systolic BP below 120 mmHg is seems to favor in CKD patients regardless of the presence or absence of diabetes. As BP control is difficult in patients with CKD, appropriate measurement of BP is important. Automated BP monitoring could reduce the so-called "white coat effect" (spike in BP) that may be triggered by measurement in a clinical setting. Moreover, out-of-office BP monitoring at home or ambulatory BP monitoring for 24 hours may provide critical information regarding diurnal BP variability and nocturnal BP in patients with CKD.
随着人口老龄化，高血压和慢性肾脏病（CKD）的患病率呈上升趋势。高血压和 CKD 密切相关，伴有 CKD 的高血压很难控制。这种控制血压（BP）的困难可以用 BP 昼夜变化的变化来解释，例如非杓型和反杓型模式、脉压增加以及 CKD 患者的 BP 可变性导致夜间高血压或隐匿性高血压的发生频率增加。未控制或夜间高血压的 CKD 患者发生心血管疾病、CKD 进展和全因死亡的风险增加。最近的研究表明，强化降低收缩压至 120mmHg 以下似乎对 CKD 患者有利，无论是否存在糖尿病。由于 CKD 患者的血压控制困难，因此适当的血压测量很重要。自动血压监测可以减少临床环境下测量可能引发的所谓“白大衣效应”（BP 飙升）。此外，在家中进行的非诊室 BP 监测或 24 小时动态血压监测可提供有关 CKD 患者日间 BP 变异性和夜间 BP 的重要信息。
