Asserraji Mohammed, Bouzerda Abdelmajed, Soukrate Safia, Maoujoud Omar, Belarbi Merouane, Zemraoui Nadir, Bendriss Leila, Khatouri Ali
Department of Nephrology, Avicenne Military Hospital and Marrakech School of Medicine, Cadi Ayyad University, Marrakech, Morocco.
Department of Cardiology, Mohammed V Armed Forces Hospital, Rabat, Morocco.
Saudi J Kidney Dis Transpl. 2019 Jul-Aug;30(4):913-918. doi: 10.4103/1319-2442.265468.
Among patients with chronic kidney disease (CKD), hypertension (HTN) is very common and widely recognized to accelerate the progression of CKD and increase the risk for cardiovascular events. Accumulated data indicate that ambulatory blood pressure monitoring (ABPM) is better in detecting HTN than office blood pressure (BP) measurement. The goal of this study is to describe the ABPM characteristics in a group of CKD and hypertensive patients. A transversal study was conducted over a period of six months, to evaluate the ABPM patterns among a group of hypertensive patients with CKD (Group 1) and compared the data with a control group (Group 2). ABPM was performed with measurement rate every 15 min during daytime and 30 min at night. Nondipping BP patterns were defined as the absence of fall in nocturnal systolic and diastolic BP >10% of daytime values. Masked HTN was defined as controlled office BP (<140/90 mm Hg) with an elevated overall average BP by 24-h ABPM (>125/75 mm Hg), and white-coat HTN was defined as association of elevated BP readings (>140/90 mm Hg) in a clinical setting and normal 24-h average BP levels (<130/80 mm Hg). Fifty patients were included in each group. HTN was much longer in duration among hypertensive patients with CKD and frequently associated with obesity, dyslipidemia, and diabetes (64% vs. 39.60%). Positive proteinuria was present in 82% of CKD patients with HTN. CKD patients with HTN received more antihypertensive drugs than Group 2 patients. HTN was much more uncontrolled among CKD patients (60% vs. 24%), more serious with higher daytime and nighttime SBP, and loss of physiologic dipping during nighttime BP measurement (80%). Out-of-office BP monitoring by ABPM may improve the assessment and the successful management of HTN in patients with CKD. Standardized definitions for the diagnosis of masked and white-coat HTN would facilitate research.
在慢性肾脏病（CKD）患者中，高血压（HTN）非常常见，并且普遍认为其会加速CKD的进展并增加心血管事件的风险。累积数据表明，动态血压监测（ABPM）在检测高血压方面比诊室血压（BP）测量更具优势。本研究的目的是描述一组CKD合并高血压患者的ABPM特征。进行了一项为期六个月的横断面研究，以评估一组CKD高血压患者（第1组）的ABPM模式，并将数据与对照组（第2组）进行比较。ABPM在白天每15分钟测量一次，夜间每30分钟测量一次。非勺型血压模式定义为夜间收缩压和舒张压下降幅度未超过白天值的10%。隐匿性高血压定义为诊室血压得到控制（<140/90 mmHg），但24小时ABPM显示总体平均血压升高（>125/75 mmHg），而白大衣高血压定义为临床环境中血压读数升高（>140/90 mmHg）且24小时平均血压水平正常（<130/80 mmHg）。每组纳入50名患者。CKD高血压患者的高血压病程更长，且常伴有肥胖、血脂异常和糖尿病（64%对39.60%）。82%的CKD高血压患者存在阳性蛋白尿。CKD高血压患者比第2组患者服用更多的降压药物。CKD患者中高血压的控制情况更差（60%对24%），白天和夜间收缩压更高，夜间血压测量时生理性勺型消失（80%）。通过ABPM进行诊室外血压监测可能会改善CKD患者高血压的评估和成功管理。隐匿性和白大衣高血压诊断的标准化定义将有助于研究。
