Masked Hypertension and Elevated Nighttime Blood Pressure in CKD: Prevalence and Association with Target Organ Damage
Masked Hypertension and Elevated Nighttime Blood Pressure in CKD: Prevalence and Association with Target Organ Damage
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DOI：
10.2215/cjn.08530815
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发表时间：
2016-04-01
影响因子：
9.8
通讯作者：
Rahman, Mahboob
中科院分区：
文献类型：
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作者：
Drawz, Paul E.;Alper, Arnold B.;Rahman, Mahboob
背景和目的在肾功能正常的患者中，隐匿性高血压和夜间血压升高与高血压靶器官损害的风险增加以及心血管和肾脏不良结局相关。隐匿性高血压对CKD住院患者的这些风险的意义还不是很清楚。这项研究的目的是评估隐匿性高血压与肾功能和心血管靶器官损害的标志物之间的关系，并确定这种关系在夜间血压升高和不升高的患者中是否一致。设计、环境、参与者和测量：这是一项横断面研究。我们对参加慢性肾功能不全队列研究的1492名慢性肾功能不全患者进行了24小时动态血压检查。根据临床血压和24小时动态血压，我们将受试者分为控制血压、白大衣高血压、蒙面高血压和持续性高血压。结果受试者中血压控制者占49.3%，白大衣者占4.1%，隐蔽者占27.8%，持续性高血压者占18.8%。与对照血压相比，隐匿性高血压独立地伴随着较低的EGFR(-3.2ml/min/1.73m(2)；95%可信区间，-5.5~-0.9)，较高的蛋白尿(比对数尿蛋白高0.9单位；95%可信区间，0.7~1.1)，较高的左心室重量指数(+2.52g/m(2.7)；95%可信区间，0.9~4.1)，和脉搏波速度(+0.92m/S；95%可信区间，0.5至1.3)。患有隐匿性高血压的参与者只有在夜间血压升高的情况下才有较低的EGFR(夜间血压升高；95%可信区间为-6.1至-1.1；夜间血压升高的参与者为-1.4ml/min；95%可信区间为-6.9至4.0
Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks inpatients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively.Results The percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (-3.2 ml/min per 1.73 m(2); 95% confidence interval,-5.5 to-0.9), higher proteinuria (+0.9 unit higher in log(2) urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m(2.7); 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (-3.6 ml/min per 1.73 m2; 95% confidence interval,-6.1 to -1.1; versus -1.4 ml/min per 1.73 m2; 95% confidence interval, -6.9 to 4.0, among those with nighttime BP