诊间血压变异性对肾功能中度受损高血压患者肾功能的影响  

Impact of visit-to- visit variability in blood pressure on renal function of stage 3- 4 chronickidney diseases patients with hypertension

作　　者：尹道馨[1] 张东亮[1] 徐睿[1] 冷雪飞[1] 崔文英[1] 刘文虎[1] 

机构地区：[1]首都医科大学肾病学系首都医科大学附属北京友谊医院肾内科,北京100050

出　　处：《中华肾脏病杂志》2013年第2期98-102,共5页Chinese Journal of Nephrology

基　　金：北京市科学技术委员会科技计划重大项目课题（D09050704310903,Z111107066411009）

摘　　要：目的评价慢性肾脏病（CKD）3-4期高血压患者的诊间血压变异性对肾功能下降的影响。方法152例研究对象来自首都医科大学附属北京友谊医院CKD专科门诊，每月测量患者血压，随访18个月，随访期间无降压药物的调整。计算每例研究对象随访期间的平均收缩压（SBP）、平均舒张压（DBP）及其标准差。依据SBP、DBP标准差中位数分为高SBP、高DBP标准差组和低SBP、低DBP标准差组，比较基线人口学特征及用药情况。采用多重线性回归分析SBP、DBP标准差对CKD3-4期高血压患者肾功能下降的影响。结果患者SBP、DBP标准差与肾功能下降显著相关；基线eGFR、基线尿微量白蛋白（LnACR）和随访平均SBP也对肾功能下降有影响（均P〈0．05）。低SBP标准差组患者服用钙通道阻滞剂类降压药物比例显著高于高SBP标准差组（76．1％比58．2％，P〈0．05）。结论血压变异性与CKD3-4期患者肾功能下降显著相关，提示诊间血压变异性应受到更多关注，减少血压变异性的药物应作为降压治疗的首选。Objective To clarify the clinical significance of visit-to-visit variability in blood pressure （BP） of stage 3-4 chronic kidney disease （CKD） patients with hypertension. Methods One hundred and fifty-two cases of stage 3- d CKD patients with hypertension were enrolled in the study. Variability in BP was defined as the standard deviation （SD） in BP. For each patient, SD and mean BP from BP measurements were calculated at all the visits. Correlations between the decline in estimated glomerular filtration rate （eGFR） and SD in BP were analyzed by muhivariable regression. Results Visit- to- visit variability in BP was significantly associated with renal function decline （P 〈 0.05）, in addition, baseline eGFR, baseline albuminuria and mean SBP during follow- up were significantly associated with renal function decline as well （all P 〈 0.05）. The percentage of CCBs used in low SD of the SBP group was higher than that in high SD of the SBP （76.1% vs 58.2%, P 〈 0.05）. Conclusion Visit-to-visit variability in BP is significantly associated with renal function decline. Drugs which can decrease the variability of blood pressure should be the first choice in the treatment of hypertension.

关 键 词：肾疾病 高血压 变异性 血压 

分 类 号：R544.1[医药卫生—心血管疾病]