Nocturnal and Circadian Rhythm of Blood Pressure Is Associated with Renal Structure Damage and Function in Patients with IgAN
Nocturnal and Circadian Rhythm of Blood Pressure Is Associated with Renal Structure Damage and Function in Patients with IgAN
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夜间和昼夜血压节律与 IgAN 患者的肾结构损伤和功能相关
DOI：
10.1016/j.arcmed.2016.01.001
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发表时间：
2016-01-01
影响因子：
7.7
通讯作者：
He, Yani
中科院分区：
文献类型：
--
作者：
Lin, Lirong;Zhang, Huhai;He, Yani
背景和目的。高血压患者血压昼夜节律异常与靶器官损害密切相关。然而，血压昼夜节律异常与肾损伤之间的关系尚不清楚。我们研究了肾损伤是否与中国IgAN患者的夜间血压和血压昼夜节律有关。获得330例中国IgAN患者的临床和24小时动态血压监测数据，平均24小时血压< 130/80，平均白天血压< 135/85 mmHg。肾组织病理学损伤按照igan牛津分级进行判定。在330例IgAN受试者中，35.8%的人有夜间高血压，61.5%的人有昼夜血压异常，27%的人有夜间高血压，且血压不降。与夜间血压正常的患者相比，夜间高血压患者的血胱抑素C、血尿酸水平明显升高，肾小球滤过率（eGFR）估计值较低，平均肾组织损伤评分明显升高。非低血压高血压组夜间舒张压和收缩压、血尿酸和肾小球硬化率显著升高，而eGFR较低。非浸渍高血压患者尿钠排泄和肾组织损伤评分均显著高于浸渍患者。夜间高血压和昼夜血压异常与肾组织损伤、肾间质纤维化和主动脉弓动脉粥样硬化相关。血压昼夜节律异常和夜间高血压是中国IgAN患者24小时平均血压正常的常见临床表现。昼夜血压异常和夜间高血压可通过诱导肾功能障碍和组织病理学损害加速IgAN的进展。(c) 2016年度Elsevier Inc.出版。
Background and Aims. Abnormal circadian rhythm of blood pressure (BP) is closely related to target organ damage in hypertension. However, the association between abnormal circadian rhythm of BP and renal injury is not clear. We investigated whether renal injury is associated with nocturnal BP and circadian rhythm of BP in Chinese IgAN patients.Methods. Clinic and 24 h ambulatory BP monitoring data were obtained from 330 Chinese IgAN patients with mean 24 h BP < 130/80 and mean daytime BP < 135/85 mmHg. Renal histopathological injury was determined according to the Oxford classification of IgAN.Results. Among the 330 IgAN subjects, 35.8% suffered from nocturnal hypertension, 61.5% had abnormal circadian BP, and 27% had nocturnal hypertension with a nondipping pattern. Compared with nocturnal normotensive patients, patients with nocturnal hypertension had significantly higher levels of blood cystatin C, blood uric acid, and lower estimated glomerular filtration rate (eGFR), and significantly a higher mean renal tissue injury score. The nondipping hypertensive group had significantly higher nocturnal diastolic and systolic BP, blood uric acid, and glomerulosclerosis rates, whereas eGFR was lower. In nondipping hypertensive patients, urinary sodium excretion and renal tissue injury scores were significantly higher than dipping patients. Nocturnal hypertension and abnormal circadian BP correlated with renal tissue injury, renal interstitial fibrosis, and aortic arch atherosclerosis.Conclusion. Abnormal circadian rhythm of BP and nocturnal hypertension are common clinical manifestations in Chinese IgAN patients with normal mean 24 h BP. Abnormal circadian BP and nocturnal hypertension may accelerate IgAN progression by inducing renal dysfunction and histopathological damage. (C) 2016 IMSS. Published by Elsevier Inc.