Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.
Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
BMC Nephrol. 2020 Dec 11;21(1):541. doi: 10.1186/s12882-020-02200-1.
Blood pressure is an important and modifiable cardiovascular risk factor. Ambulatory blood pressure monitoring (ABPM) provides valuable prognostic information in patients with chronic kidney disease (CKD), yet little is known about the association of various types of BP measurements with target organ damage (TOD) in patients with primary glomerular disease. The goal of this study was to investigate whether ambulatory blood pressure is better associated with TOD than clinic blood pressure in patients with primary glomerular disease.
1178 patients with primary glomerular disease were recruited in this cross-sectional study. TOD were assessed by the following 4 parameters: left ventricular mass index (LVMI or LVH, left ventricular hypertrophy), estimated glomerular filtration rate (eGFR< 60 ml/min/1.73m), albumin-to-creatinine ratio (ACR ≥ 30 mg/g) and carotid intima-media thickness (cIMT) or plaque. Receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to evaluate the relationship between ambulatory or clinic systolic blood pressure (SBP) indexes and TOD.
Among 1178 patients (mean age, 39 years,54% men), 116, 458, 1031 and 251 patients had LVH, eGFR < 60 ml/min/1.73m, ACR ≥ 30 mg/g and cIMT≥0.9 mm or plaque respectively. Area under ROC curves for TOD in ambulatory SBP, especially nighttime SBP, was greater than that in clinic SBP (P < 0.05). Multivariate logistic regression analyses showed that 24 h SBP, daytime SBP and nighttime SBP were significantly associated with LVH, eGFR< 60 ml/min/1.73m and ACR ≥ 30 mg/g after adjustment for clinic SBP, while the association of clinic SBP was attenuated after further adjustment for nighttime SBP.
Ambulatory blood pressure, especially nighttime blood pressure, is probably superior to clinic blood pressure and has a significant association with TOD in primary glomerular disease patients.
血压是心血管的重要且可调节的风险因素。动态血压监测（ABPM）可在慢性肾脏病（CKD）患者中提供有价值的预后信息，但对于原发性肾小球疾病患者，各种血压测量值与靶器官损害（TOD）的关系知之甚少。本研究的目的是探讨原发性肾小球疾病患者中，动态血压与 TOD 的相关性是否优于诊室血压。
本横断面研究共纳入 1178 例原发性肾小球疾病患者。通过以下 4 个参数评估 TOD：左心室质量指数（LVMI 或 LVH，左心室肥厚）、估算肾小球滤过率（eGFR<60 ml/min/1.73m）、白蛋白与肌酐比值（ACR≥30 mg/g）和颈动脉内膜中层厚度（cIMT）或斑块。使用受试者工作特征（ROC）曲线和多变量逻辑回归分析评估动态或诊室收缩压（SBP）指标与 TOD 的关系。
在 1178 例患者（平均年龄 39 岁，54%为男性）中，116、458、1031 和 251 例患者分别存在 LVH、eGFR<60 ml/min/1.73m、ACR≥30 mg/g 和 cIMT≥0.9mm 或斑块。动态 SBP，尤其是夜间 SBP 的 TOD 的 ROC 曲线下面积大于诊室 SBP（P<0.05）。多变量逻辑回归分析表明，在校正诊室 SBP 后，24 h SBP、日间 SBP 和夜间 SBP 与 LVH、eGFR<60 ml/min/1.73m 和 ACR≥30 mg/g 显著相关，而在校正夜间 SBP 后，诊室 SBP 的相关性减弱。
动态血压，尤其是夜间血压，可能优于诊室血压，与原发性肾小球疾病患者的 TOD 显著相关。
