Loss of nighttime blood pressure dipping as a risk factor for coronary artery calcification in nondialysis chronic kidney disease.
Loss of nighttime blood pressure dipping as a risk factor for coronary artery calcification in nondialysis chronic kidney disease.
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DOI：
10.1097/md.0000000000007380
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发表时间：
2017-06
期刊：
影响因子：
1.6
通讯作者：
Kim BS
中科院分区：
文献类型：
--
作者：
Choi HY;Lee CJ;Lee JE;Yang HS;Kim HY;Park HC;Kim HC;Chang HJ;Park SH;Kim BS
血压（BP）下降的昼夜变化与靶器官损伤和心血管事件密切相关。冠状动脉钙化（CAC）的数量与动脉粥样硬化斑块负荷相关，数量增加表明心血管事件的风险大幅增加。本研究调查了慢性肾脏病（CKD）患者中与CAC相关的血压下降的夜间昼夜变化。在1958名参与者中，我们招募了722名CKD参与者，他们没有急性冠状动脉综合征或症状性冠状动脉疾病的病史。CAC用计算机断层扫描测量。采用24小时动态血压监测测量血压。使用SphygmoCor波形分析系统测量中心BP。CAC患者的24小时收缩压、白天收缩压和夜间收缩压动态血压和中心收缩压显著升高。在CAC患者中，出现浸渍损失的参与者比例显著较高。多变量logistic回归分析表明，在调整传统和非传统心血管危险因素和其他BP参数（包括办公室测量的BP和中心BP）后，倾斜损失和倾斜比率与CAC独立相关。在考虑传统风险因素和办公室测量的BP后，采用净重分类改进和综合判别改进，改进了CAC的浸渍状态风险预测。血压昼夜变化的夜间丢失是CKD患者CAC的独立危险因素。
Diurnal variations in blood pressure (BP) loss are closely associated with target organ damage and cardiovascular events. The quantity of coronary artery calcification (CAC) correlates with the atherosclerotic plaque burden, and an increased quantity indicates a substantially increased risk of cardiovascular events. This study investigated the nighttime diurnal variation in BP loss associated with CAC in patients with chronic kidney disease (CKD). Of the 1958 participants, we enrolled 722 participants with CKD without a history of acute coronary syndrome or symptomatic coronary artery disease. CAC was measured with computed tomography. BP was measured using 24-hour ambulatory BP monitoring. Central BP was measured using a SphygmoCor waveform analysis system. Participants with CAC had significantly higher 24-hour systolic, daytime systolic, and nighttime systolic ambulatory BP and central systolic BP. The percentage of participants with dipping loss was significantly higher among those with CAC. Multivariate logistic regression analysis indicated that dipping loss and dipping ratio were independently associated with CAC after adjusting for traditional and nontraditional cardiovascular risk factors and other BP parameters, including measurements of office-measured BP and central BP. The dipping status improved risk prediction for CAC after considering traditional risk factors and office-measured BP, using the net reclassification improvement and integrated discrimination improvement. Nighttime loss of diurnal variation in BP is an independent risk factor for CAC in CKD patients.