動態(tài)血壓評價慢性腎臟病合并高血壓患者的血壓節(jié)律及降壓的時間治療學研究
發(fā)布時間：2019-01-08 09:37
【摘要】：目的了解動態(tài)血壓監(jiān)測在慢性腎臟病患者評價血壓節(jié)律中的作用；探討降壓時間治療學在慢性腎臟病合并高血壓患者中的應用價值。 方法1.調(diào)查2012年7月-2013年9月期間中南大學湘雅三醫(yī)院、北京安貞醫(yī)院、郴州市第一人民醫(yī)院腎內(nèi)科、心內(nèi)科住院及門診的222名高血壓患者。入選后均停用既往降壓藥物,予氨氯地平5mg/天,導入1周。同時收集其基本資料、實驗室檢查及導入1周時的動態(tài)血壓及同日的診室血壓。分析不同程度腎功能損害的高血壓患者及假性血壓達標患者的血壓節(jié)律及夜間血壓。 2.觀察2012年7月-2013年9月期間中南大學湘雅三醫(yī)院、北京安貞醫(yī)院、郴州市第一人民醫(yī)院腎內(nèi)科、心內(nèi)科住院及門診的高血壓患者155例,應用同期平行對照研究的方法,治療8周。比較分析晨起頓服或夜間服用以氨氯地平為基礎(chǔ)的降壓藥兩種降壓治療方案的有效性。 3.通過檢索Medline(1950-)、EMbase (1974-)、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBLD,1978-)和Cochrane臨床對照試驗數(shù)據(jù)庫(簡稱CENTRAL),收集慢性腎臟病合并高血壓患者時間降壓治療的隨機對照臨床研究。由兩名獨立研究者按照納入與排除標準進行文獻篩選、質(zhì)量評價和數(shù)據(jù)提取后,對CKD患者的時間降壓治療的臨床研究做系統(tǒng)評價。 結(jié)果1.對CKD合并高血壓患者的血壓進行分析,結(jié)果表明,隨著腎功能損害加重,血壓逐漸升高,杓型血壓的比例逐漸降低(P=0.003),其中eGFR下降(P0.001)、肥胖(P0.001)、男性(P=0.022)是夜間收縮壓升高的獨立影響因素。中重度腎功能損害患者(CKD3-5期)的診室血壓均高于動態(tài)血壓(P0.001)。與診室收縮壓和24小時平均收縮壓、白天平均收縮壓之間的差異相比,診室收縮壓與夜間平均收縮壓之間的差異最大(4.90±14.72、2.63±14.76vs.10.35±16.76,P0.001),提示診室血壓無法準確評價CKD合并高血壓患者的夜間血壓。 2.對CKD合并假性血壓達標患者臨床改變進行分析比較,結(jié)果顯示,有23.30%的高血壓患者為假性血壓達標,其中81.13%(43/53)假性血壓達標患者伴有異常血壓節(jié)律；21.62%的高血壓患者為夜間孤立性高血壓。腎功能下降是夜間孤立性高血壓發(fā)生的獨立影響因素(OR=0.972,95%CI:0.954-0.991)。 3.CKD合并高血壓患者時間降壓治療學的同期平行對照研究結(jié)果表明,與早晨頓服以氨氯地平為基礎(chǔ)的降壓藥物相比,夜間服用超過1種降壓藥可有效降低CKD合并夜間孤立性高血壓患者的24小時平均收縮壓(P=0.045)、24小時平均舒張壓(P=0.021)、白天平均收縮壓(P=0.035)、夜間平均收縮壓(P=0.036)、夜間平均舒張壓(P=0.019),但不降低CKD合并高血壓患者的血壓；校正eGFR后,夜間組的夜間平均舒張壓下降(P=0.034)較早晨組仍有統(tǒng)計學意義。 4.CKD合并高血壓患者夜間降壓治療隨機對照研究的系統(tǒng)評價結(jié)果顯示,與早晨頓服所有降壓藥相比,夜間服用常規(guī)降壓藥對CKD合并高血壓患者的全因死亡率(P=0.056)或心血管事件死亡率(P=0.059)無影響,但可顯著降低所有不良事件的發(fā)生率(HR=0.31,P0.001)；可降低夜間平均收縮壓5.88mmHg (95%CI3.16to8.59,P0.0001),降低夜間平均舒張壓2.49mmHg (95%CI0.84to4.14,P=0.003)。 結(jié)論1.動態(tài)血壓可有效評估CKD患者的假性血壓達標情況及血壓節(jié)律； 2.夜間服用常規(guī)降壓藥物可顯著降低CKD合并高血壓患者的夜間血壓,預防心血管事件的發(fā)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
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R544.1;R692
本文編號：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
【學位授予單位】：中南大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R544.1;R692
【參考文獻】
相關(guān)期刊論文 前1條
1 劉力生;;中國高血壓防治指南2010[J];中華高血壓雜志;2011年08期
，本文編號：2404422
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