Is Nocturnal Blood Pressure Reduction the Secret to Reducing the Rate of Progression of Hypertensive Chronic Kidney Disease?
Is Nocturnal Blood Pressure Reduction the Secret to Reducing the Rate of Progression of Hypertensive Chronic Kidney Disease?
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DOI：
10.1007/s11906-011-0217-8
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发表时间：
2011-10-01
影响因子：
5.6
通讯作者：
Drawz, Paul E.
中科院分区：
文献类型：
--
作者：
Mehta, Rupal;Drawz, Paul E.
高血压是心血管和肾脏疾病的重要危险因素。降低血压（BP）已被证明可以降低心血管疾病的发病率，但随机试验尚未证明降低血压对肾脏疾病进展有好处，除非对有明显蛋白尿的患者进行二次分析。最近，人们对使用家庭血压监测和动态血压监测 (ABPM) 在诊所外测量血压越来越感兴趣。 ABPM 的优点是可以全天测量血压。与白天或诊所血压升高相比，夜间血压升高和血压从白天到晚上没有下降（非下降）是心血管和肾脏结果更有效的危险因素。研究表明，通过晚上服用抗高血压药物（称为时间疗法）可以降低夜间血压并恢复正常血压。晚上服用抗高血压药物不仅可以降低夜间血压，还可以减少尿蛋白排泄、减少心血管事件和降低全因死亡率。降低夜间血压可能会减缓慢性肾脏疾病的进展，并且可能是将高血压治疗与改善肾脏结局联系起来的关键。
Hypertension is a significant risk factor for cardiovascular and renal disease. Lowering blood pressure (BP) has been shown to reduce the incidence of cardiovascular disease, but randomized trials have not demonstrated a benefit of lowering BP for the progression of renal disease except in secondary analyses in patients with significant proteinuria. Recently, there has been increasing interest in measuring BP outside of the clinic, using both home and ambulatory blood pressure monitoring (ABPM). ABPM has the advantage of measuring BP throughout both the day and night. Elevated nighttime BP and a lack of decline in BP from day to night (nondipping) are more potent risk factors for cardiovascular and renal outcomes than elevated daytime or clinic BP. Studies have shown that it is possible to lower nighttime BP and restore normal dipping with the administration of antihypertensive medications in the evening, known as chronotherapy. Evening administration of antihypertensives not only lowers nighttime BP but also is associated with decreased urinary protein excretion, decreased cardiovascular events, and decreased all-cause mortality. Reducing nighttime BP may slow the progression of chronic kidney disease and may be the key to linking the treatment of hypertension with improved renal outcomes.