Department of Nephrology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
Department of Cardiology, Bursa Uludag University Faculty of Medicine, Bursa, Turkey.
Ren Fail. 2021 Dec;43(1):223-230. doi: 10.1080/0886022X.2020.1864403.
The activation of the sympathetic nervous system, which usually leads to a swift surge in blood pressure in the morning hours (MBPS) may be the cause of left ventricular hypertrophy (LVH) and endothelial dysfunction (ED) in early autosomal dominant polycystic kidney disease (ADPKD) patients. We studied the association between MBPS and LVH in ADPKD patients with preserved renal functions.
Patients with ADPKD with preserved renal functions were enrolled. Prewaking MBPS was calculated using ambulatory blood pressure monitoring. The patients were categorized as MBPS (≥median) and non-MBPS (<median). Left ventricular mass index (LVMI), endothelial-dependent dilatation (FMD, %), and carotid intima-media thickness (CIMT) evaluated.
Fifty-six patients (30 females and 26 males) were enrolled. Gender distribution was similar-among-the-groups. The mean age was higher in the MBPS group (50.1 ± 13 vs 37.3 ± 10.3). Urinary albumin (49.5 vs 16 mg/g creatinine, < 0.001), hs-CRP (0.59 vs 0.37 mg/dl, = 0.045) LVMI (124 ± 27.7 vs 95.2 ± 19.7 g/m, < 0.001) and mean awake SBP surge was higher (42 vs 20 mmHg, < 0.001) and FMD (%) was lower (14.4 ± 6.6 vs 18.9 ± 5.7, = 0.009) in MBPS group. In the binary logistic regression analysis, the presence of MBPS in model 1 (OR: 6.625, 95% CI [1.048-41.882] = 0.044), and age in model 2 (OR: 1.160, 95% CI [1.065-1.263] = 0.001) were the only independent determinant of LVH.
MBPS seems to be an important and independent determinant of LVH in ADPKD patients with preserved renal functions. It may be worth assessing the effect of reduction in MBPS as a new therapeutic target to prevent LVH in-patients-with-ADPKD.
自主神经的激活通常会导致清晨血压迅速升高（MBPS），这可能是常染色体显性遗传性多囊肾病（ADPKD）患者左心室肥厚（LVH）和内皮功能障碍（ED）的原因。我们研究了保留肾功能的 ADPKD 患者中 MBPS 与 LVH 之间的关系。
纳入了保留肾功能的 ADPKD 患者。使用动态血压监测计算预醒 MBPS。将患者分为 MBPS（≥中位数）和非 MBPS（<中位数）。评估左心室质量指数（LVMI）、内皮依赖性扩张（FMD，%）和颈动脉内膜中层厚度（CIMT）。
共纳入 56 例患者（30 名女性和 26 名男性）。组间性别分布相似。MBPS 组的平均年龄较高（50.1±13 岁 vs 37.3±10.3 岁）。尿白蛋白（49.5 与 16mg/g 肌酐， <0.001）、hs-CRP（0.59 与 0.37mg/dl， =0.045）、LVMI（124±27.7 与 95.2±19.7g/m， <0.001）和平均清醒 SBP 升高（42 与 20mmHg， <0.001）更高，FMD（%）较低（14.4±6.6 与 18.9±5.7， =0.009）在 MBPS 组。在二元逻辑回归分析中，模型 1 中存在 MBPS（OR：6.625，95%CI[1.048-41.882] =0.044），以及模型 2 中的年龄（OR：1.160，95%CI[1.065-1.263] =0.001）是 LVH 的唯一独立决定因素。
MBPS 似乎是保留肾功能的 ADPKD 患者 LVH 的重要和独立决定因素。评估降低 MBPS 作为预防 ADPKD 患者 LVH 的新治疗靶点的效果可能是值得的。
