【摘要】 目的了解偶测血压正常的慢性肾脏病(CKD)患者的动态血压特点。方法选择350例CKD1至5期偶测血压正常的患者,根据血压水平分为血压正常组(146例)和血压高值组(204例),另选择50名健康者为正常对照组。应用美国Spacelab无创便携式动态血压监测仪测量24h(8:00—次日8:00)、日间(6:00—22:00)、夜间(22:00—次日6:00)的动态血压数据(包括收缩压、舒张压、血压负荷、平均动脉压)的均值。每例患者仅统计日间动态血压升高(又称隐性高血压)、夜间动态血压升高和24h动态血压升高其中一种动态血压升高类型,不重复统计。观察CKD患者的动态血压、血压模式和动态血压负荷情况,3组患者隐性高血压和昼夜节律消失的发生情况,并比较3组患者的偶测血压、动态血压和动态血压负荷值。结果 350例偶测血压正常的CKD患者中,动态血压升高147例(42.0%),其中隐性高血压69例(19.7%);昼夜节律消失199例(56.9%);动态血压负荷升高204例(58.3%,以夜间动态血压负荷升高为主)。血压正常组隐性高血压发生率为11.0%(16/146),显著低于血压高值组的26.0%(53/204,P<0.01);正常对照组出现昼夜节律消失4例(8.0%)。血压正常组的偶测血压(收缩压、舒张压)均显著低于正常对照组(P值均<0.01),夜间动态血压(夜间收缩压、夜间舒张压)均显著高于正常对照组(P值均<0.01);血压高值组的偶测血压、24h动态血压、日间动态血压、夜间动态血压均显著高于正常对照组和血压正常组(P值均<0.01)。血压正常组的夜间动态血压负荷均显著高于正常对照组(P值均<0.01);血压高值组的24h血压负荷、日间动态血压负荷、夜间动态血压负荷均显著高于正常对照组和血压正常组(P值均<0.01);血压高值组和血压正常组的日间收缩压负荷显著高于同组的夜间收缩压负荷(P值均<0.01),而日间舒张压负荷显著低于同组的夜间舒张压负荷(P值均<0.01)。结论在偶测血压正常的CKD患者中,存在动态血压均值升高、隐性高血压、夜间高血压、血压负荷和昼夜节律消失的情况,应当引起重视。更多还原

【Abstract】 Objective To evaluate the characteristics of ambulatory blood pressure in chronic kidney disease(CKD)patients with normal casual blood pressure.Methods Three hundred and fifty CKD 1-5grade patients with normal causal blood pressure were assigned to CKD normal blood pressure group(n=146)and elevated normal blood pressure groups(n=204).Fifty healthy people were taken as controls.The 24-hour blood pressure(including systolic blood pressure,diastolic blood pressure,the load of blood pressure,the mean of arterial blood pressure)was monitored by Spacelab ambulatory blood pressure instruments,including the blood pressure of daytime(6:00-22:00),nocturnal blood pressure(22:00-6:00)and 24-hour ambulatory blood pressure.The increased daytime ambulatory blood pressure was also known as masked hypertension.Only one type of increased ambulatory blood pressure was counted in each patient.The ambulatory blood pressure,blood pressure pattern,load of blood pressure,masked hypertension,and circadian rhythm disappear were observed in CKD patients.The casual blood pressure,ambulatory blood pressure and load of blood pressure were compared between three groups.Results In 350 CKD patients,there were 147 cases with increased ambulatory blood pressure(42.0%),69 cases with masked hypertension(19.7%),199 cases with circadian rhythm disappear(56.9%),and 204 cases with increased load of blood pressure(58.3%,mainly happened at night).The prevalence of masked hypertension was 11.0%(16/146)in normal blood pressure group,which was significantly lower than that in elevated normal blood pressure group(26.0%,53/204,P <0.01).Circadian rhythm disappeared in 4cases(8.0%)in healthy control group.Compared with those in healthy control group,the casual blood pressure(systolic blood pressure and diastolic blood pressure)were significantly decreased in normal blood pressure group(both P<0.01),while nocturnal ambulatory blood pressure(systolic blood pressure and diastolic blood pressure)were significantly increased(both P<0.01).The casual blood pressure,24-hour ambulatory blood pressure,daytime blood pressure and night blood pressure in elevated normal blood pressure group were all significantly higher than those in control group and normal blood pressure group(all P<0.01).The night blood pressure load in normal blood pressure group were significantly higher than that in control group(both P<0.01).The 24-hour blood pressure load,daytime blood pressure load and night blood pressure load in elevated normal blood pressure group were all significantly higher than those in control groups and normal blood pressure group(all P<0.01).The daytime systolic blood pressure load were significantly higher than the night systolic blood pressure load in two CKD groups(both P<0.01),while daytime diastolic blood pressure load were significantly lower than the night diastolic blood pressure load in the same groups(both P<0.01).Conclusion Abnormal conditions such as increased ambulatory blood pressure,masked hypertension,nocturnal hypertension,abnormal blood pressure load and circadian rhythm disappear may exist in CKD patients with normal causal blood pressure.更多还原