Blood Pressure Characteristics In Moderate To Severe Renal Insufficiency

OBJECTIVE:Ambulatory blood pressure monitoring (ABPM) in chronic kidney disease (CKD) patients has been extensively studied, but few investigations have attempted to relate ABPM with CKD stages, especially nobody having studying on comparing blood pressure (BP) load, mean arterial pressure (MAP) or heart rate (HR) in patients with combined hypertension and CKD according to CKD stage classification. The objectives of this article were to investigated ABPM and renal injury in combined hypertension and CKD. We supposed ABPM was important in combined hypertension and CKD.METHODS:We compared 24-hour ABPM with BP parameters in 241 hypertension patients, including 152 patients with combined hypertension and stage 1 through stage 5 CKD. For this study, patients with combined hypertension and CKD were grouped according to severity into stages 1 through 3 (Stage 1-3) and stages 4 and 5 (Stage 4-5).RESULTS:In the Stage 4-5 group, systolic BP (SBP) (daytime, nighttime and 24 h mean), diastolic BP (DBP), pulse pressure and SBP standard deviations (SD) (daytime and 24 h) were higher (p< 0.05). Waking, sleeping and 24-h SBP and DBP loads were significantly higher in the Stage 4-5 group. The nighttime load was higher than the daytime load. MAP was higher in the Stage 4-5 group. HR were faster in the Stage 4-5 group. The proportion of patients with the riser BP rhythm, and thus the highest CVD risk, increased from 26.4% in the Stagel-3 group to 34.8% in the Stage 4-5 group. The proportion of patients with a 24 h PP mean> 53 mm Hg significantly differed between the Stage 1-3 and Stage 4-5 groups,79.5% in the Stage 4-5 group as opposed to 54.3% in the Stage 1-3 group (p< 0.05). The prevalence of non-dipping rhythm was quite high (78.3%) in patients with combined hypertension and CKD and increased with the deterioration of renal function (73.6% vs.89.1%).Nighttime SBP SD, DBP SD, HR SD and HR relative decline in time asleep were similar between the two groups.CONCLUSION:Ambulatory BP parameters were associated with risk to develop end-stage renal disease and target organ damage. Daytime, nighttime and 24 h SBP and DBP loads, MAP were higher in the Stage 4-5 CKD group, the nighttime SBP and DBP loads were higher than the daytime load. HR were faster in the Stage 4-5 group. The present study confirmed the greater relationship of ABPM with renal insufficiency including patients with very low glomerular filtration rate.