Association Between Change in Central Nocturnal Blood Pressure and Urine Albumin-Creatinine Ratio by a Valsartan/Amlodipine Combination: A CPET Study.
Association Between Change in Central Nocturnal Blood Pressure and Urine Albumin-Creatinine Ratio by a Valsartan/Amlodipine Combination: A CPET Study.
复制标题
缬沙坦/氨氯地平组合引起的夜间中心血压变化与尿白蛋白-肌酐比值之间的关联：一项 CPET 研究。
DOI：
10.1093/ajh/hpy078
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发表时间：
2018
期刊：
影响因子：
3.2
通讯作者：
Kario K.
中科院分区：
文献类型：
--
作者：
Fujiwara T;Yano Y;Hoshide S;Kanegae H;Hashimoto J;Kario K.
研究目的：评价缬沙坦/氨氯地平（80/5 mg）联合治疗高血压患者后，肱动脉或中心夜间收缩压（SBP）变化与尿白蛋白-肌酐比值（UACR）变化的关系。（年龄范围，47-78岁;平均，68.0岁; 35%男性，65%患有慢性肾脏疾病）临床肱动脉BP ≥140/90 mm Hg的患者接受缬沙坦/曲马多联合治疗16周。在基线和16周后，我们使用示波Mobil-O-Graph装置测量了23例患者的肱动脉和中心动脉夜间收缩压，并通过点尿测量了UACR。结果肱动脉夜间收缩压（r= 0.445，P = 0.033）和中心动脉夜间收缩压（r= 0.616，P = 0.002）的变化与干预后UACR的变化显着相关。在多因素校正的多元回归分析中，只有夜间中心收缩压的变化与UACR的变化有统计学意义（β = 0.919，P = 0.020）。结论缬沙坦/缬沙坦联合治疗降低夜间中心收缩压与UACR的降低有关，与夜间肱动脉收缩压的降低无关。中枢性夜间收缩压可能是保护肾脏的治疗靶点。需要更大规模的干预性研究来证实降低夜间中心收缩压对肾脏的保护作用。
BACKGROUNDWe aimed to assess the association of changes in brachial or central nocturnal systolic blood pressure (SBP) with change in urine albumin–creatinine ratio (UACR) by a valsartan/amlodipine combination (80/5 mg) therapy in hypertensive patients.METHODSTwenty-three patients (age range, 47–78 years; mean, 68.0 years; 35% men, 65% with chronic kidney disease) with clinic brachial BP ≥140/90 mm Hg were treated with valsartan/amlodipine combination therapy for 16 weeks. At baseline and 16 weeks later, we measured brachial and central nocturnal SBP using an oscillometric Mobil-O-Graph device and UACR by spot urine in 23 patients.RESULTSThe changes in brachial nocturnal SBP (r= 0.445,P= 0.033) and those in central nocturnal SBP (r= 0.616,P= 0.002) were significantly associated with change in UACR by intervention. In multivariable-adjusted multiple regression analyses including changes in both brachial and central nocturnal SBP jointly, only central nocturnal SBP change retained a statistically significant association with change in UACR (β = 0.919,P= 0.020).CONCLUSIONSLowering central nocturnal SBP by a valsartan/amlodipine combination therapy was associated with reduction of UACR, independently of brachial nocturnal SBP reduction. Central nocturnal SBP may be a therapeutic target to protect the kidney. A larger scale interventional study will be needed to confirm the kidney protection conferred by lowering central nocturnal SBP.CLINICAL TRIALS REGISTRATIONTrial Number UMIN000013519.