To Explore The Blood Pressure Management Strategy Of Chronic Kidney Disease Based On Ambulatory Arterial Stiffness Index

Backgrounds and Objectives:The blood pressure is not well controlled in patients with chronic kidney disease(CKD).Hypertension is closely related to arterial stiffness and cardiovascular and cerebrovascular events.Ambulatory arterial stiffness index(AASI)can reflect arterial stiffness and predict the morbidity and mortality of cardiovascular and cerebrovascular diseases.This study was based on the investigation of the current situation of blood pressure control in patients with CKD complicated with hypertension in our hospital.We have analyzed the factors that influence AASI in patients with CKD and explored the blood pressure indexes that have the greatest impact on AASI.So as to provide references for clinical blood pressure management.Materials and Methods:From May 2014 to April 2019,we selected 443 patients with CKD combined with hypertension who received 24-hour ambulate blood pressure monitoring in the nephropathy department of our hospital into the study.General clinical data,biochemical indexes and ambulate blood pressure of the subjects were collected retrospectively.The first part analyzed the blood pressure control of patients with CKD complicated with hypertension in our hospital.We divided the objects into two groups: blood pressure achieved the target group and blood pressure not achieved the target group,and AASI values of the two groups were compared by independent sample t test.The second part analyzed the correlation between AASI and the general clinical characteristics,drugs and blood pressure indexes of CKD patients by univariate analysis.The least absolute shrinkage and selection operator(LASSO)regression model was established to find the blood pressure indexes with the greatest influence on AASI.So as to provide references for clinical blood pressure management.Results:1.The 24-hour,daytime and nocturnal blood pressure compliance rates of patients with CKD complicated with hypertension in our hospital were 25.5%,35.8% and 11.9%.And the 24-hour,daytime and nocturnal blood pressure compliance rates of non-dialysis patients were 29.9%,40.5% and 15.0%.2.The difference of AASI between those who achieved the target of nocturnal blood pressure and those who did not was statistically significant(P=0.045).The difference of AASI between those who achieved the target of daytime blood pressure and those who did not was statistically significant(P=0.025).There was no statistically significant difference of AASI between those who achieved the target of 24-hour blood pressure and those who did not(P=0.081).3.Pearson or Spearman correlation coefficient analysis showed that AASI was associated with age(r=0.277,P<0.001),hemoglobin(r=-0.121,P=0.012),cystatin C(r=0.0098,P=0.043),carotid intima-media thickness(r=0.336,P<0.001).Independent sample t test or single factor analysis of variance shows that AASI was associated with gender(P=0.007),etiology(P=0.001),primary hypertension(P<0.001),diabetes mellitus(P=0.002),coronary heart disease(P<0.001),cerebral infarction(P<0.001),calcium channel blocker(P=0.004).And there was no correlation between AASI and dialysis or dialysis mode(P=0.240).4.Pearson or Spearman correlation coefficient analysis showed that AASI was associated with 24-hour systolic blood pressure(r=0.249,P<0.001),24-hour diastolic blood pressure(r=-0.153,P=0.001),24-hour pulse pressure(r=0.430,P<0.001),daytime systolic blood pressure(r=0.221,P<0.001),daytime diastolic blood pressure(r=-0.167,P<0.001),daytime pulse pressure(r=0.420,P<0.001),nocturnal systolic blood pressure(r=0.317,P<0.001),nocturnal pulse pressure(r=0.444,P<0.001),nocturnal mean arterial pressure(r=0.115,P=0.017),standard deviation of 24-hour heart rate(r=-0.151,P=0.002),standard deviation of 24-hour diastolic blood pressure(r=-0.496,P<0.001),standard deviation of daytime diastolic blood pressure(r=-0.448,P<0.001),standard deviation of daytime systolic blood pressure(r=0.099,P=0.039),standard deviation of daytime heart rate(r=-0.151,P=0.002),standard deviation of nocturnal heart rate(r=-0.119,P=0.013),standard deviation of nocturnal diastolic blood pressure(r=-0.288,P<0.001).Single factor analysis of variance showed that AASI was associated with blood pressure circadian rhythm(P=0.000).5.LASSO regression analysis showed that AASI was independently positively correlated with age,gender,primary hypertension,coronary heart disease,cerebral infarction,daytime pulse pressure,nocturnal mean arterial pressure,standard deviationof 24-hour heart rate,standard deviation of daytime systolic blood pressure,standard deviation of nocturnal heart rate,and AASI was independently negatively correlated with 24-hour diastolic blood pressure,standard deviation of 24-hour diastolic blood pressure,standard deviation of daytime diastolic blood pressure.Among them,standard deviation of 24-hour diastolic blood pressure and standard deviation of daytime systolic blood pressure had the greatest influence on AASI,the B value was-0.10190 and0.07960,respectively.Conclusions:1.Patients with CKD complicated with hypertension had a low rate of reaching the target of blood pressure at night,and non-spoon and anti-spoon were the more common types of blood pressure circadian rhythm.AASI was higher in those whose daytime or nocturnal blood pressure did not reach the target.So we should pay more attention to reaching the target of daytime and nocturnal blood pressure.2.AASI can comprehensively reflect various indicators of blood pressure.And this study found a correlation between AASI and calcium channel blockers.3.This study found that the standard deviation of 24-hour diastolic blood pressure and the standard deviation of daytime systolic blood pressure have the greatest influence on AASI.Blood pressure variability may be an important target spot for CKD blood pressure management.Systolic variability may be a better intervention point.