Early Risk Assessment And Differences Of Curative Effect In Hypertensive Patients With Renal Damage

Objective:1. To screen and explore related risk factors for hypertensive patients with early renal damage, establish early-warning model of renal damage based on the data-mining method;2. To investigate situation of medication and blood pressure control of hypertensive patients with severe renal damage, establish model of evaluate curative effects of amlodipine by quantitative method. Method:1. The study of risk assessment in hypertensive patients with early renal damage:with the aid of "electronic information management system for hypertensive specialist out-patient", we collected513cases of original untreated hypertensive patients, and recorded their demographic data, ambulatory blood pressure parameters, biochemical indexesmethods to establish the clinical database, propensity score matching of two groups in comparable, selected risk factor of early renal damage patients by single and multiple factors method, using technique of linear regression, artificial neural network and the random forest algorithm for early warning risk assessment respectively, we adopted the way of cross validation to evaluation stability and reliability of the model, Wilcox test were carried out to determine the best prediction model.2. Research on curative effect in hypertensive patients with severe renal damage:using the established database of the renal hypertension, through physical examination, laboratory tests, ambulatory blood pressure monitoring methods, we collected225patients with severe renal damage of hypertension, and then analyzed the situation of clinical medication and blood pressure control of different monitoring methods. Then,68cases were selected by cluster sampling and amlodipine was used as model drug intervention for8weeks, test pharmacokinetic and pharmacodynamic indexes, population pharmacokinetic/pharmacodynam-ic therapy model of amlodipine was established and validated using software NONMEM7.2and FOCEI method. Result:1. Parameters of night-time blood pressure level, blood pressure circadian rhythm and blood pressure variability were closely related to ACR （P<0.05）.â–³NSBP was independent risk factors for early renal damage （β-0.252, P<0.05）2. ACR was significantly correlated to Metabolic Syndrome Components （P<0.05）, ACR positive patients increase along in the number of MS components. FBG damaged, HDL reduced and MS may increase risk of early renal damage （P<0.05）3. ACR was closely related to the level of RDW （P<0.05）, ACR positive patients increase along in the levels of RDW （P<0.05）4. Renal damage early-warning model dependent variable （Y） mAlb_yn, after filtering, independent variable set:’dipping₄’,’SBP_night_down’,’MS count’,’RDW’. That is, blood pressure circadian rhythm, nighttime systolic blood pressure drop rate, number of components of metabolic syndrome and red cell distribution width.5. Patients with severe renal damage of hypertension had high blood pressure and were more likely to have metabolic abnormalities （P<0.05）; CCB is the most common antihypertensive drugs, and its utilization rate is as high as92.71%（P<0.05）6. Target rate of blood pressure in patients with severe renal impairment is cSBP29.30%and cDBP29.30%,24h average BP up to standard is16.52%and16.52%respectively;Day average BP standard25.00%,26.79%, night BP standard10.27%,8.48%; combination is superior to single drug use （P<0.05）7. Reason of difference acquired antihypertensive effects including age, weight, smoking, diet, drug combination and degree of renal impairment, which is the most important influencing factors （P<0.05）8. For severe renal damage patients with hypertension, amlodipine EsBP parameter model fitting results:treatment2weeks of SBP, reduce the value of25.9mmHg,8weeks up to maximum effect is32.6mmHg, maximize reduce50%SBP effect of amlodipine blood concentrations is7.71ng/mL; EDBP parameter:treatment2weeks of DBP reduce the value of3.4mmHg,8weeks up to the biggest effect is13.6mmHg, get a maximum reduce the effects of DBP50%amlodipine blood concentrations is13.4ng/mL. Conclusion1. Abnormal blood pressure circadian rhythm, metabolic components number and red cell distribution width are early warning signs of the untreated hypertension patients with kidney damage. Early-warning risk model is stable and reliable based on the algorithm of data-mining.2. Target rate of blood pressure is low in severe renal damage patients with hypertension, amlodipine is the most common antihypertensive drugs in this population, amlodipine treatment for8weeks when the concentration of the drugs-effect model is stable and reliable based on quantitative pharmacology.