Gatzka C D, Schobel H P, Klingbeil A U, Neumayer H H, Schmieder R E
Department of Internal Medicine IV-Nephrology, University of Erlangen-Nürnberg, Germany.
Transplantation. 1995 May 15;59(9):1270-4.
Most patients with secondary hypertension due to renal disease or on maintenance hemodialysis have lost the physiologic fall of blood pressure during sleep. To test the notion that kidney transplantation normalizes the blood pressure profile, we monitored ambulatory blood pressure over 24 hr in 45 patients (29 males and 16 females) after successful renal transplantation. The longer the time after renal transplantation, the more marked was the decrease of blood pressure during sleep (r = 0.38, P < 0.01). This effect of time after renal transplantation on the fall of blood pressure during sleep was independent of the prevailing level of 24-hr ambulatory blood pressure. The prevalence of dippers (defined by a fall in mean blood pressure during sleep of 10% or more of the awake mean) increased from 27% in the early phase (< 7 months) to 73% in the late phase (> or = 1 year) after renal transplantation (P < 0.01). Again, this effect was not attributable to the level of 24-hr ambulatory blood pressure and concomitant antihypertensive or immunosuppressive medication. We conclude that renal transplantation leads to a normalization of the circadian blood pressure profile with a marked decrease of blood pressure during sleep. As a consequence, the lower hemodynamic load imposed on the cardiovascular system may in turn lead to a reduction of cardiovascular morbidity and mortality.
大多数因肾病或维持性血液透析导致继发性高血压的患者，睡眠期间已失去血压的生理性下降。为了验证肾移植可使血压模式恢复正常这一观点，我们对45例（29例男性和16例女性）肾移植成功后的患者进行了24小时动态血压监测。肾移植后时间越长，睡眠期间血压下降越明显（r = 0.38，P < 0.01）。肾移植后时间对睡眠期间血压下降的这种影响，与24小时动态血压的普遍水平无关。勺型血压者（定义为睡眠期间平均血压下降幅度达到清醒时平均血压的10%或更多）的比例，在肾移植后的早期阶段（< 7个月）为27%，到后期阶段（≥ 1年）增加至73%（P < 0.01）。同样，这种影响并非归因于24小时动态血压水平以及同时使用的抗高血压或免疫抑制药物。我们得出结论，肾移植可使昼夜血压模式恢复正常，睡眠期间血压显著下降。因此，施加于心血管系统的较低血流动力学负荷可能进而导致心血管发病率和死亡率降低。
