Salagre Santosh B, Ansari Nigarbi N A, Mali Vandana S
Department of Medicine, Seth G.S Medical College and KEM Hospital, Mumbai, Maharashtra, India.
Indian J Nephrol. 2021 Jul-Aug;31(4):365-369. doi: 10.4103/ijn.IJN_394_19. Epub 2021 Feb 8.
Hypertension leads to rapid progression of kidney disease. Hypertension (HTN) is the second most common cause for CKD after diabetes. Ambulatory blood pressure monitoring (ABPM) helps in accurate and early diagnosis of HTN along with measurements of other variables, namely nondippers, reverse dippers, hyperbaric index (HBI), percentage time elevation (PTE), and early morning surge.
After obtaining the institution ethics committee approval total 192 cases, of 12-80 years age group, who were diagnosed with CKD were included in the study. ABPM was done for patients using Meditech ABPM-05 machine.
Study showed male predominance. Maximum patients were in the age group of 41-60 years. Prevalence of Hypertension in patients with CKD was 88.02%. The systolic BP, diastolic BP, and mean arterial pressure (MAP) were significantly higher by clinic BP measurement than ABPM in all stages of patients with CKD especially in stage IV than stage V CKD. Systolic, diastolic, MAP, HBI and PTE at nighttime were significantly higher than daytime in all patients with CKD, especially in patients with resistant hypertension. Prevalence of whitecoat HTN (4.1%), whitecoat effect (16.1%), resistant hypertension (39.6%), masked HTN (1%), and masked uncontrolled HTN (10.4%) was noted. Systolic and diastolic HBI was lower in patients on hemodialysis as compared to those not on hemodialysis. Non-dippers were more than dippers.
Apart from mean systolic and diastolic BP, ABPM gives the extent of end-organ damage and insights into the need for control of 24 h BP in patients of CKD.
高血压会导致肾脏疾病快速进展。高血压（HTN）是继糖尿病之后慢性肾脏病（CKD）的第二大常见病因。动态血压监测（ABPM）有助于准确、早期诊断高血压，并可测量其他变量，即非杓型血压、反杓型血压、高压指数（HBI）、血压升高百分比时间（PTE）和清晨血压激增。
在获得机构伦理委员会批准后，本研究纳入了192例年龄在12 - 80岁、被诊断为CKD的患者。使用Meditech ABPM - 05机器为患者进行动态血压监测。
研究显示男性占主导。最大患者群体在41 - 60岁年龄组。CKD患者中高血压患病率为88.02%。在CKD患者的所有阶段，尤其是IV期患者与V期CKD患者相比，通过诊室血压测量得到的收缩压、舒张压和平均动脉压（MAP）显著高于动态血压监测结果。在所有CKD患者中，夜间的收缩压、舒张压、MAP、HBI和PTE显著高于白天，尤其是在顽固性高血压患者中。记录到白大衣高血压（4.1%）、白大衣效应（16.1%）、顽固性高血压（39.6%）、隐匿性高血压（1%）和隐匿性未控制高血压（10.4%）的患病率。与未进行血液透析的患者相比，接受血液透析的患者收缩压和舒张压HBI较低。非杓型血压者多于杓型血压者。
除了平均收缩压和舒张压外，动态血压监测还能反映终末器官损害程度，并为了解CKD患者24小时血压控制需求提供见解。
