Diagnosis And Evaluation Of Renal Injury In The Early Stage Of Essential Hypertension And Its Correlation With Blood Pressure And Pulse Pressure

Objectives:1.To observe the correlation between different diastolic and systolic blood pressure levels and early kidney injury in patients with essential hypertension.2.To observe whether the pulse pressure and pulse pressure index of patients with essential hypertension are correlated with early renal injury.3.Evaluation of blood retinol binding protein and random urine N-acetylationβ-The diagnostic value of D-glucosaminidase,trace total protein,and NAG creatinine ratio in early renal injury.Methods:A total of 265 patients with essential hypertension who met the inclusion criteria from January 2020 to December 2022 were selected from the inpatients and outpatients of the Department of Cardiology of the First Affiliated Hospital of Kunming Medical University,including 146 males and 119 females.Collect and record the basic data of patients,such as name,sex,age,height,weight,hypertension grade,use of antihypertensive drugs before treatment,smoking and drinking history,etc.,improve the relevant examination and collect the auxiliary examination data of patients,including blood biochemistry,random urine early renal injury,dynamic two-in-one.Randomized urinary albumin creatinine ratio≥30mg/g was used as the judgment standard for early renal injury.Among the patients included,urinary albumin creatinine ratio<30mg/g was negative group(201 cases in total),and urinary albumin creatinine ratio ≥ 30mg/g was positive group(64 cases in total).The correlation between diastolic blood pressure,systolic blood pressure,pulse pressure and pulse pressure index in patients with essential hypertension and early renal injury was analyzed by statistical methods;To evaluate the diagnostic value of serum retinol binding protein,urine NAG,total protein and creatinine ratio of NAG in early renal injury.Results:1.There were statistical differences in the combined diseases(stroke,diabetes),triglycerides,low-density lipoprotein,and chloride concentration between the two groups(p<0.05).2.After correction of stroke,diabetes,triglyceride,low-density lipoprotein and chloride concentration,multivariate regression analysis showed that diastolic blood pressure and systolic blood pressure were independent risk factors for early renal injury(p<0.05);The higher the diastolic blood pressure,the greater the risk of renal injury;The risk of renal injury in DBP≥100mm Hg group was higher than that in SBP≥140mm Hg group.3.The increase of blood pressure at night increases the risk of kidney injury and the risk ratio of kidney injury: NADBP(12.79)>24h DBP(7.09)>DADBP(6.72),NASBP(7.68)>24h SBP(5.90)>DASBP(4.64).4.According to 24 h PP,patients were divided into three groups: 24 h PP <50mm Hg,50 mm Hg≤24h PP<60mm Hg,24 h PP≥60mm Hg.The results showed that the risk of renal injury increased when 24 h PP≥60mm Hg(p<0.05);According to24 h PPI,it was divided into two subgroups:24h PPI<0.4 and 24 h PPI>0.4.There was no significant difference between the two groups by multiple regression analysis(p>0.05),and PPI was not correlated with early renal injury.5.There was no significant correlation between blood RBP,random urine NAG and early renal injury(p>0.05).The ratio of random urine trace total protein and NAG creatinine could be used to judge early renal injury,and the difference between single factor and multiple factor analysis was statistically significant(p<0.05).The AUC value of early renal injury in hypertension detected by each index was:the combined detection of trace total protein and NAG creatinine ratio(0.812)>trace total protein(0.790)>NAG creatinine ratio(0.709).Conclusions:1.Diastolic and systolic blood pressure are independent risk factors for early renal injury;The higher the diastolic blood pressure,the greater the risk of renal injury;Elevated blood pressure at night significantly increases the risk of kidney injury.2.Pulse pressure can be used as an indicator of early renal injury.This study shows that the risk of renal injury increases when PP≥60mm Hg at 24 h.3.Random urine trace total protein and NAG creatinine ratio can be used to judge early renal injury,and the combined detection is better than the independent detection of each index in judging early renal injury in hypertension.