动态血压评价慢性肾脏病合并高血压患者的血压节律及降压的时间治疗学研究
发布时间：2019-01-08 09:37
【摘要】：目的了解动态血压监测在慢性肾脏病患者评价血压节律中的作用；探讨降压时间治疗学在慢性肾脏病合并高血压患者中的应用价值。 方法1.调查2012年7月-2013年9月期间中南大学湘雅三医院、北京安贞医院、郴州市第一人民医院肾内科、心内科住院及门诊的222名高血压患者。入选后均停用既往降压药物,予氨氯地平5mg/天,导入1周。同时收集其基本资料、实验室检查及导入1周时的动态血压及同日的诊室血压。分析不同程度肾功能损害的高血压患者及假性血压达标患者的血压节律及夜间血压。 2.观察2012年7月-2013年9月期间中南大学湘雅三医院、北京安贞医院、郴州市第一人民医院肾内科、心内科住院及门诊的高血压患者155例,应用同期平行对照研究的方法,治疗8周。比较分析晨起顿服或夜间服用以氨氯地平为基础的降压药两种降压治疗方案的有效性。 3.通过检索Medline(1950-)、EMbase (1974-)、中国生物医学文献数据库(CBLD,1978-)和Cochrane临床对照试验数据库(简称CENTRAL),收集慢性肾脏病合并高血压患者时间降压治疗的随机对照临床研究。由两名独立研究者按照纳入与排除标准进行文献筛选、质量评价和数据提取后,对CKD患者的时间降压治疗的临床研究做系统评价。 结果1.对CKD合并高血压患者的血压进行分析,结果表明,随着肾功能损害加重,血压逐渐升高,杓型血压的比例逐渐降低(P=0.003),其中eGFR下降(P0.001)、肥胖(P0.001)、男性(P=0.022)是夜间收缩压升高的独立影响因素。中重度肾功能损害患者(CKD3-5期)的诊室血压均高于动态血压(P0.001)。与诊室收缩压和24小时平均收缩压、白天平均收缩压之间的差异相比,诊室收缩压与夜间平均收缩压之间的差异最大(4.90±14.72、2.63±14.76vs.10.35±16.76,P0.001),提示诊室血压无法准确评价CKD合并高血压患者的夜间血压。 2.对CKD合并假性血压达标患者临床改变进行分析比较,结果显示,有23.30%的高血压患者为假性血压达标,其中81.13%(43/53)假性血压达标患者伴有异常血压节律；21.62%的高血压患者为夜间孤立性高血压。肾功能下降是夜间孤立性高血压发生的独立影响因素(OR=0.972,95%CI:0.954-0.991)。 3.CKD合并高血压患者时间降压治疗学的同期平行对照研究结果表明,与早晨顿服以氨氯地平为基础的降压药物相比,夜间服用超过1种降压药可有效降低CKD合并夜间孤立性高血压患者的24小时平均收缩压(P=0.045)、24小时平均舒张压(P=0.021)、白天平均收缩压(P=0.035)、夜间平均收缩压(P=0.036)、夜间平均舒张压(P=0.019),但不降低CKD合并高血压患者的血压；校正eGFR后,夜间组的夜间平均舒张压下降(P=0.034)较早晨组仍有统计学意义。 4.CKD合并高血压患者夜间降压治疗随机对照研究的系统评价结果显示,与早晨顿服所有降压药相比,夜间服用常规降压药对CKD合并高血压患者的全因死亡率(P=0.056)或心血管事件死亡率(P=0.059)无影响,但可显著降低所有不良事件的发生率(HR=0.31,P0.001)；可降低夜间平均收缩压5.88mmHg (95%CI3.16to8.59,P0.0001),降低夜间平均舒张压2.49mmHg (95%CI0.84to4.14,P=0.003)。 结论1.动态血压可有效评估CKD患者的假性血压达标情况及血压节律； 2.夜间服用常规降压药物可显著降低CKD合并高血压患者的夜间血压,预防心血管事件的发生。
[Abstract]:Objective To study the role of ambulatory blood pressure monitoring in the evaluation of blood pressure rhythm in patients with chronic kidney disease. The method 1. Investigation of 222 hypertension patients in Central South University, Xiangya Hospital of Central South University, Beijing Anzhen Hospital, First People's Hospital of Meizhou City, Department of Cardiology, and Outpatient Clinic, July 2012 to September, 2013 1. Prior antihypertensive drugs were discontinued following the inclusion, and received at 5mg/ day for Amlodipine, and introduced into 1 Week. At the same time, the basic data, the laboratory tests and the dynamic blood pressure at 1 week and the blood pressure on the same day were collected. Pressure. Analysis of blood pressure rhythm and night blood of patients with high blood pressure and pseudo-blood pressure in different degrees of renal function impairment Pressure. 2. Observe 155 cases of hypertension in Central South University, Xiangya Third Hospital, Beijing Anzhen Hospital, First People's Hospital of Meizhou City, Department of Cardiology and Outpatient, in July 2012-September 2013, and apply the method of parallel control study in the same period to treat Treatment for 8 weeks. Comparison of two antihypertensive treatment regimens based on amlodipine in the morning of morning or at night Effectiveness. 3. By retrieving Medline (1950-), EMbase (1974-), Chinese Biomedical Literature Database (CBLD, 1978-) and Cochrane Clinical Control Test Database (CENTRAL), a random pair of time-and-step-down treatment for patients with chronic kidney disease and hypertension was collected. According to the clinical study, a clinical study of time-down treatment of patients with CKD was performed by two independent investigators in accordance with the inclusion and exclusion criteria for literature screening, quality evaluation and data extraction system evaluation Results 1. The blood pressure of patients with CKD combined with hypertension was analyzed. The results showed that with the worsening of renal function, the blood pressure gradually increased, and the ratio of the blood pressure to the blood pressure decreased gradually (P = 0.003), in which the eGFR decreased (P 0.001), the obesity (P 0.001), and the male (P = 0.022) was the increase of the systolic blood pressure at night. The blood pressure of the office in patients with moderate to severe renal impairment (CKD3-5) was higher than that of ambulatory blood pressure (The difference between the in-room systolic and the nighttime mean systolic blood pressure was the largest (4.90, 14.72, 2.63, 14.76vs. 10.35, 16.76, P0.001), as compared to the room systolic and the 24-hour mean systolic blood pressure and the daytime mean systolic pressure, suggesting that the patient's blood pressure could not accurately assess the combination of CKD with hypertension The results showed that 23. 30% of the patients with high blood pressure met the standard of pseudo-blood pressure, of which 81.13% (43/ 53) of the patients with pseudo-blood pressure met the abnormal blood pressure rhythm, and 21. 62% of the patients with hypertension For nocturnal isolated hypertension, the decrease in renal function was an independent factor of the occurrence of nocturnal isolated hypertension (OR = 0.972, 95% CI: 0.9 54-0. 991). 3. The concurrent parallel control study of time-and-step-down treatment for patients with CKD with high blood pressure showed that in the morning, it was taken with ammonia and chlorine The 24-hour mean systolic pressure (P = 0.045), mean diastolic blood pressure (P = 0.021), daytime mean systolic pressure (P = 0.035), daytime mean systolic pressure (P = 0.036), and night mean systolic pressure (P = 0. 036) were effective in the treatment of patients with CKD with nocturnal isolated hypertension, as compared to a flat-based step-down drug. Tension (P = 0.019), but did not reduce the blood pressure in patients with CKD combined with hypertension; after the eGFR was corrected, the daytime mean diastolic blood pressure in the night group decreased (P = 0.034) In the morning group, there was still a statistical significance. 4. The systematic evaluation of the randomized controlled study of nocturnal blood pressure reduction in patients with CKD with hypertension showed that the full-cause mortality (P = 0. 056) or the death of cardiovascular events in patients with CKD-associated hypertension compared to all antihypertensive agents in the morning The rate (P = 0.059) had no effect, but the incidence of all adverse events was significantly reduced (HR = 0.31, P0.001); the mean systolic blood pressure at night was reduced by 5.88mmHg (95% CI 3.16to8. 59, P. 0001), and the mean diastolic blood pressure at night was 2.49mmHg (95% CI 0.84to 4. 14 P = 0. 003). Conclusion 1. Dynamic blood pressure can be used to assess the risk of CKD People's pseudo-blood pressure compliance and blood pressure rhythm; 2. The administration of conventional step-down drugs at night can significantly reduce the risk of CKD combined with hypertension
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.1;R692
本文编号：2404422
[Abstract]:Objective To study the role of ambulatory blood pressure monitoring in the evaluation of blood pressure rhythm in patients with chronic kidney disease. The method 1. Investigation of 222 hypertension patients in Central South University, Xiangya Hospital of Central South University, Beijing Anzhen Hospital, First People's Hospital of Meizhou City, Department of Cardiology, and Outpatient Clinic, July 2012 to September, 2013 1. Prior antihypertensive drugs were discontinued following the inclusion, and received at 5mg/ day for Amlodipine, and introduced into 1 Week. At the same time, the basic data, the laboratory tests and the dynamic blood pressure at 1 week and the blood pressure on the same day were collected. Pressure. Analysis of blood pressure rhythm and night blood of patients with high blood pressure and pseudo-blood pressure in different degrees of renal function impairment Pressure. 2. Observe 155 cases of hypertension in Central South University, Xiangya Third Hospital, Beijing Anzhen Hospital, First People's Hospital of Meizhou City, Department of Cardiology and Outpatient, in July 2012-September 2013, and apply the method of parallel control study in the same period to treat Treatment for 8 weeks. Comparison of two antihypertensive treatment regimens based on amlodipine in the morning of morning or at night Effectiveness. 3. By retrieving Medline (1950-), EMbase (1974-), Chinese Biomedical Literature Database (CBLD, 1978-) and Cochrane Clinical Control Test Database (CENTRAL), a random pair of time-and-step-down treatment for patients with chronic kidney disease and hypertension was collected. According to the clinical study, a clinical study of time-down treatment of patients with CKD was performed by two independent investigators in accordance with the inclusion and exclusion criteria for literature screening, quality evaluation and data extraction system evaluation Results 1. The blood pressure of patients with CKD combined with hypertension was analyzed. The results showed that with the worsening of renal function, the blood pressure gradually increased, and the ratio of the blood pressure to the blood pressure decreased gradually (P = 0.003), in which the eGFR decreased (P 0.001), the obesity (P 0.001), and the male (P = 0.022) was the increase of the systolic blood pressure at night. The blood pressure of the office in patients with moderate to severe renal impairment (CKD3-5) was higher than that of ambulatory blood pressure (The difference between the in-room systolic and the nighttime mean systolic blood pressure was the largest (4.90, 14.72, 2.63, 14.76vs. 10.35, 16.76, P0.001), as compared to the room systolic and the 24-hour mean systolic blood pressure and the daytime mean systolic pressure, suggesting that the patient's blood pressure could not accurately assess the combination of CKD with hypertension The results showed that 23. 30% of the patients with high blood pressure met the standard of pseudo-blood pressure, of which 81.13% (43/ 53) of the patients with pseudo-blood pressure met the abnormal blood pressure rhythm, and 21. 62% of the patients with hypertension For nocturnal isolated hypertension, the decrease in renal function was an independent factor of the occurrence of nocturnal isolated hypertension (OR = 0.972, 95% CI: 0.9 54-0. 991). 3. The concurrent parallel control study of time-and-step-down treatment for patients with CKD with high blood pressure showed that in the morning, it was taken with ammonia and chlorine The 24-hour mean systolic pressure (P = 0.045), mean diastolic blood pressure (P = 0.021), daytime mean systolic pressure (P = 0.035), daytime mean systolic pressure (P = 0.036), and night mean systolic pressure (P = 0. 036) were effective in the treatment of patients with CKD with nocturnal isolated hypertension, as compared to a flat-based step-down drug. Tension (P = 0.019), but did not reduce the blood pressure in patients with CKD combined with hypertension; after the eGFR was corrected, the daytime mean diastolic blood pressure in the night group decreased (P = 0.034) In the morning group, there was still a statistical significance. 4. The systematic evaluation of the randomized controlled study of nocturnal blood pressure reduction in patients with CKD with hypertension showed that the full-cause mortality (P = 0. 056) or the death of cardiovascular events in patients with CKD-associated hypertension compared to all antihypertensive agents in the morning The rate (P = 0.059) had no effect, but the incidence of all adverse events was significantly reduced (HR = 0.31, P0.001); the mean systolic blood pressure at night was reduced by 5.88mmHg (95% CI 3.16to8. 59, P. 0001), and the mean diastolic blood pressure at night was 2.49mmHg (95% CI 0.84to 4. 14 P = 0. 003). Conclusion 1. Dynamic blood pressure can be used to assess the risk of CKD People's pseudo-blood pressure compliance and blood pressure rhythm; 2. The administration of conventional step-down drugs at night can significantly reduce the risk of CKD combined with hypertension
【学位授予单位】：中南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.1;R692
【参考文献】
相关期刊论文 前1条
1 刘力生;;中国高血压防治指南2010[J];中华高血压杂志;2011年08期
，本文编号：2404422
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