Relationship of Ambulatory Blood Pressure and the Heart Rate Profile with Renal Function Parameters in Hypertensive Patients with Chronic Kidney Disease
Relationship of Ambulatory Blood Pressure and the Heart Rate Profile with Renal Function Parameters in Hypertensive Patients with Chronic Kidney Disease
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DOI：
10.3109/10641963.2012.681082
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发表时间：
2012-01-01
影响因子：
12.3
通讯作者：
Umemura, Satoshi
中科院分区：
文献类型：
--
作者：
Kanaoka, Tomohiko;Tamura, Kouichi;Umemura, Satoshi
据报道，严格控制血压（BP）对高血压合并慢性肾脏疾病（CKD）患者的管理很重要。本横断面研究的目的是探讨25例连续住院的高血压合并CKD患者的动态血压、心率（HR）谱、中央血流动力学和动脉硬度等变量是否与肾功能参数（尿白蛋白排泄率[UACR]和肾小球滤过率[eGFR]）密切相关。UACR与24小时、白天和夜间动态收缩压呈显著正相关。此外，UACR与24小时和白天HR变异性呈显著负相关。循环b型利钠肽水平和血红蛋白A1c也与UACR呈正相关。关于eGFR，尽管24小时和夜间HR变异性与eGFR呈正相关，但循环戊苷和夜间HR与eGFR呈负相关。另一方面，中央血流动力学和动脉硬度与肾功能参数没有明显的相关性。这些结果表明，动态血压和HR谱与肾功能恶化密切相关。高血压合并CKD患者动态血压与HR谱和肾功能参数之间的因果关系有待进一步研究。
Strict blood pressure (BP) control is reportedly important for the management of hypertensive patients with chronic kidney disease (CKD). The purpose of this cross-sectional study was to examine whether the variables of ambulatory BP and the heart rate (HR) profile, central hemodynamics, and arterial stiffness were closely related to the renal function parameters (urine albumin excretion rate [UACR] and estimated glomerular filtration rate [eGFR]) observed in 25 consecutive hospitalized hypertensive patients with CKD. There were significant positive relationships between UACR and 24-hour, daytime, and nighttime ambulatory systolic BP. In addition, there were significant negative relationships between UACR and 24-hour and daytime HR variability. The circulating B-type natriuretic peptide level and hemoglobin A1c were also positively related to UACR. With respect to eGFR, although the 24-hour and nighttime HR variability were positively associated with eGFR, the circulating pentosidine and nighttime HR had a negative relationship with eGFR. On the other hand, central hemodynamics and arterial stiffness did not exhibit any significant association with renal function parameters. These results indicate that ambulatory BP and the HR profile are closely modulated by renal function deterioration. Further studies are needed to investigate the causal relationship between ambulatory BP and the HR profile and renal function parameters in hypertensive patients with CKD.