Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Kidney Dis. 2024 May;18(3):150-158. doi: 10.52547/q4b5rx79.
Ambulatory blood pressure monitoring (ABPM) is a valuable tool for detecting abnormalities in nighttime blood pressure (BP), including non-dipping and nighttime hypertension. These abnormalities are independent predictors of a poor prognosis in patients with chronic kidney disease (CKD). The aim of our study was to analyze ABPM data and evaluate nighttime BP abnormalities in an Iranian CKD population.
This cross-sectional study was conducted on sixty two patients at stages III and IV of CKD who were referred to a nephrology clinic in Tehran, Iran. The patients were classified as either dippers (19.4%) or non-dippers (80.6%), as well as nighttime normotensives (38.7%) or hypertensives (61.3%), based on ABPM data and in accordance with 2023 ESC/ESH guidelines. We compared demographic data, estimated glomerular filtration rate (eGFR), and daytime BP levels among these groups.
The mean age of patients was 56.34 years, with 61.1% of them being male. Daytime pulse pressure was significantly greater in non-dippers compared to dippers (52.67 vs. 44 mmHg, P = .02). We found a significant correlation between the extent of BP dipping and eGFR (R = 0.281, P = .02). Systolic and diastolic daytime BP levels were significantly higher in individuals with nighttime hypertension. Diabetic patients were more likely to be non-dippers and have nighttime hypertension. After adjusting for age, diabetes mellitus, and daytime pulse pressure in a multivariable model, we determined that eGFR independently predicted the extent of BP dipping.
Our results showed that both non-dipping and nighttime hypertension are highly prevalent in CKD patients, but they have distinct contributing factors. The eGFR was identified as an independent predictor of BP dipping, whereas nighttime BP levels were primarily determined by daytime BP levels. DOI: 10.52547/ijkd.7559.
动态血压监测（ABPM）是检测夜间血压（BP）异常的一种有价值的工具，包括非杓型和夜间高血压。这些异常是慢性肾脏病（CKD）患者预后不良的独立预测因素。我们的研究目的是分析伊朗 CKD 人群的 ABPM 数据并评估夜间 BP 异常。
这是一项横断面研究，共纳入 62 名在伊朗德黑兰肾脏病诊所就诊的 CKD 3 期和 4 期患者。根据 ABPM 数据并按照 2023 ESC/ESH 指南，患者被分为杓型（19.4%）或非杓型（80.6%），以及夜间正常血压者（38.7%）或高血压者（61.3%）。我们比较了这些组之间的人口统计学数据、估计肾小球滤过率（eGFR）和日间 BP 水平。
患者的平均年龄为 56.34 岁，其中 61.1%为男性。非杓型患者的日间脉压明显高于杓型患者（52.67 与 44mmHg，P =.02）。我们发现 BP 下降幅度与 eGFR 之间存在显著相关性（R = 0.281，P =.02）。夜间高血压患者的收缩压和舒张压日间 BP 水平明显升高。糖尿病患者更可能是非杓型和夜间高血压。在校正年龄、糖尿病和日间脉压后，多变量模型显示 eGFR 独立预测 BP 下降幅度。
我们的结果表明，非杓型和夜间高血压在 CKD 患者中都很常见，但它们有不同的影响因素。eGFR 被确定为 BP 下降的独立预测因素，而夜间 BP 水平主要由日间 BP 水平决定。DOI：10.52547/ijkd.7559.
