Features of ambulatory blood pressure in 540 patients with chronic kidney disease

Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease (CKD) patients. Methods A total of 540 CKD patients from May 2010 to May 2012 in our department were enrolled in this study. Ambulatory blood pressure monitoring was carried out. Blood pressure (BP), proteinuria and other clinical parameters were measured regularly. Ultrasonography was used to evaluate cardiac structure and function, carotid intima-media thickness and plaque. Univariate and multivariate analysis were used to examine the association between BP and clinical parameters. Results 63.9% of CKD patients was non-dipper BP pattern, and 36.1% was dipper BP pattern. As compared to dipper BP patients, those with non--dipper BP had higher ratio of nighttime/daytime proteinuria (0.51±0.29 vs 0.42±0.21, P＜0.01), lower estimated glomerular filtration rate (eGFR) [(56.2±48.2) vs (75.5±56.5) ml•min-1•（1.73 m2）-1, P＜0.01], higher serum cystatin C[(2.8±2.0) mg/L vs (2.1±2.0) mg/L, P＜0.01], higher left ventricular mass index [(53.7±23.2) vs (45.1±16.3) g/m2, P＜0.01] and severely damaged left ventricular diastolic function and higher carotid intima-media thickness [(0.7±0.3) vs (0.6±0.2) mm, P＜0.01]. Nighttime blood pressure was independent predictor for proteinuria, eGFR and left ventricular mass index. Conclusions Non-dipper blood pressure pattern is very common in CKD patients. Nighttime pressure is closely associated to renal damage and cardiovascular injuries.     

慢性肾脏病患者血压非勺型节律与左心室肥厚之间的关系

目的 探讨24 h动态血压（ABPM）非勺型节律与慢性肾脏病（CKD）患者左心室肥厚（LVH）之间的关系。 方法 共有257例CKD 1~5期患者入选,根据肾功能分为两组：CKD1~3期组和CKD4~5期组。采用GE Marquette Tonoport V Eng动态血压计测定各组患者动态血压参数和昼夜节律;心脏彩色多普勒超声了解心脏结构的改变,并探讨血压非勺型节律与LVH之间的关系。 结果 CKD患者血压正常的生理节律丧失的现象普遍,总体血压非勺型昼夜节律发生率达75.4％,即使在血压正常者中也达到71.3%,随着肾功能下降血压非勺型昼夜节律的发生率也在上升。CKD患者血压非勺型节律组的心脏结构改变较勺型组明显,LVH的发生率也较高。相关性分析显示左室心肌质量指数（LVMI）与血压水平、非勺型的昼夜节律等相关。多元逐步回归分析显示24 h-收缩压（SBP）（β = 0.417,P < 0.01）、三酰甘油 （β = -0.132,P = 0.007）、血红蛋白（Hb）（β = -0.394,P = 0.016）及性别（β = 0.158,P = 0.039）是影响LVMI的独立危险因素。 结论 CKD患者的血压非勺型昼夜节律现象普遍,并随着肾功能的下降其发生率逐渐升高。血压非勺型节律患者心脏结构改变更明显,LVH的发生率高。非勺型节律与LVMI密切相关。     

慢性肾脏病患者血压昼夜节律异常的研究

目的 观察慢性肾脏病(CKD)患者24 h血压动态变化，探讨昼夜节律异常与肾功能损害的关系。方法 随机选择本院肾脏科CKD患者236例，高血压科原发性高血压住院患者43例。病例分组:正常对照组(NC)14例；原发性高血压组(EHC)43例；CKD血压正常组(NCKD)130例；CKD伴血压升高组(HCKD)106例。动态血压监测(ABPM)采用携带式的动态血压检测仪，ABP Report Mangement System Version 1.03.03进行数据分析。夜间血压下降率:(白昼平均值-夜间平均值)/白昼平均值，下降率≥10%，称勺型血压；<10%，称非勺型血压。结果 在血压正常的患者中，NCKD组的平均夜间收缩压和舒张压数值均高于NC组[(111.2±10.8)比 (91.6±7.5)，(68.7±9.5) 比 (56.2±4.6)mm Hg，P < 0.05]；而日间收缩压和舒张压无明显差异。在高血压患者中，HCKD组患者夜间收缩压和舒张压数值均高于EHC组[(141.9±16.5) 比(118.6±16.4)， (84.5±10.6)比(73.0±11.1)mm Hg， P < 0.05]。CKD患者无论血压正常或升高，其心率均较其对照组明显加快，尤其是夜间心率无明显下降。NCKD组、HCKD组与NC组、EHC组相比，夜间收缩压和舒张压下降数值较小，尤其是CKD伴血压升高组，呈典型的非勺型血压模式。NC组血压节律消失者占7.14%，EHC组为37.2%，NCKD组为70.0%，HCKD组为81.6%。结论 CKD患者无论血压正常或升高，夜间收缩压和舒张压下降减少或消失，呈典型的非勺型血压；血压昼夜节律异常率明显高于原发性高血压患者。在积极降低血压值的同时，还需降低血压负荷和调整血压昼夜节律，以延缓肾功能恶化。     

慢性肾脏病患者动态血压参数及血压变异的特点分析

目的 分析慢性肾脏病（chronic kidney disease,CKD）患者动态血压参数与肾小球滤过率（GFR）及尿蛋白定量的相关性,并探讨血压变异性参数特点.方法 收集首次治疗的伴有高血压及蛋白尿的CKD患者70例.测量肾功能、24 h尿蛋白定量等生化检测结果,采用动态血压监测仪监测24 h血压并记录参数.根据GFR将患者分为CKD1~2期组和CKD3~5期组.根据24 h尿蛋白定量分为以下3组：Ⅰ组＜1.0 g,Ⅱ组1.0～3.5 g,Ⅲ组＞3.5 g.比较各组动态血压参数,并探讨监测结果与肾功能及蛋白尿的关系.结果 随着患者肾功能恶化,24 h收缩压、舒张压、脉压差、白昼收缩压、夜间收缩压等指标明显升高（P＜0.05）,且与GFR成负相关,白昼收缩压是GFR下降的独立危险因素.Ⅲ组的白昼舒张压（92.94±15.32）mm Hg明显高于Ⅰ组的（85.25±8.64）mm Hg（P＜0.05）.白昼舒张压与蛋白尿水平呈正相关（r=0.257,P=0.032）.所有患者舒张压变异性均明显高于收缩压变异性（P＜0.05）.结论 本研究样本中收缩压与肾功能恶化明显相关,白昼收缩压和舒张压分别与GFR下降及蛋白尿有关,舒张压变异性应受到更多重视.     

慢性肾脏病患者24小时动态血压的特点分析

目的采用24h动态血压监测的方法,分析慢性肾脏病（CKD）不同分期患者24h动态血压特点。方法将152例CKD患者分为5组：CKD1期组（A组）15例;CKD2期组（B组）29例;CKD3期组（C组）42例;CKD4期（D组）组34例;CKD5期组（E组）32例。所有患者均无糖尿病、非肾脏替代治疗。采用携带式的动态血压检测仪测定各组患者动态血压参数和昼夜节律。结果①随着肾功能下降,24h、日间和夜间平均收缩压越来越高;②CKD患者总体非杓型血压比例为81．6o,4,肾功能下降组（CKD2～5期）非杓型血压比例显著高于肾功能正常组（CKD1期）;③夜间收缩压与24h尿蛋白定量呈正相关（r=0．427,P〈0．01）,与。肾小球滤过率（GFR）呈负相关（r=-0．352,P〈0．05）。结论CKD患者的血压非杓型节律现象比较普遍,并随着肾功能下降,其发生率逐渐升高;夜间收缩压与尿蛋白排泄、肾功能有相关性。     

Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease

Abstract

Although both clinic blood pressure (BP) variability and home BP variability are associated with the risk of cardiovascular disease, the relationship between both BP variabilities remain unclear. We evaluated the association between visit-to-visit variability of clinic BP (VVV) and day-by-day home BP variability (HBPV) in patients with chronic kidney disease (CKD). We recruited 143 CKD patients in whom we performed HBP measurements every morning and evening over seven consecutive days. We obtained clinic BP data during 9.6?±?1.0 consecutive visits within 24 months. The associations between the variables of VVV and HPBV were examined. The CV values of clinic systolic BP (CSBP) was significantly correlated with the mean values of morning systolic BP (MSBP) and those of evening systolic BP (ESBP) (r?=?0.23, 0.20; p?=?0.007, 0.02, respectively). The CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP (r?=?0.19, 0.31; p?=?0.02, <0.001, respectively). On the multivariate regression analysis, the CV values of CSBP was significantly correlated with the CV values of MSBP and those of ESBP [standardized regression coefficient (β)?=?0.19, 0.34; p?=?0.03, <0.001, respectively]. In conclusion, VVV showed a weak but significant association with HBPV, especially the CV values of ESBP in CKD patients. Further studies are necessary to clarify whether these different BPV elements will be alternative marker of BPV.     

Features of ambulatory blood pressure in 808 patients with primary glomerular disease and their correlation with target organ damage

Objective To explore the features of ambulatory blood pressure in patients with primary glomerular disease and their correlation with target organ damage (TOD)． Methods Patients with primary glomerular disease admitted to the Nephrology Department, the Third Affiliated Hospital of Sun Yat?sen University from May 2010 to May 2015 were enrolled. Ambulatory blood pressure monitoring (ABPM), clinical BP, ultrasonographic assessment and other clinical data were collected. Univariate and multivariate analyses were used to ascertain the relationship between ABPM results and clinical parameters. Results 808 patients were enrolled. Patients turned out to have a higher level of 24?hour systolic blood pressure (SBP), day?time SBP, and night?time SBP as their kidney function declined (rs=0.547, 0.538, 0.546, P＜0.01). Compared with that in CKD 1?3, The percentage of dipper blood pressure pattern decreased and that of reversed dipper blood pressure pattern increased in CKD stage 4?5 (P＜0.05). A higher level of 24 h SBP was independently associated with kidney function damage (OR=1.069, P＜0.01), and a higher level of night?time SBP was an independent factor affecting left ventricular hypertrophy (OR=1.033, P＜0.01) and reduction of diastolic function of left ventricle (OR=1.019, P＜0.01) after multivariate logistic regression analyses. Conclusion With advancing CKD stage, the level of 24 h SBP, day?time SBP, and night?time SBP was higher and the percentage of reversed dipper blood pressure pattern was higher. The parameters of ABPM were closely related to renal damage and cardiovascular injuries．     

慢性肾脏疾病患者血压变异性与血脂异常的关系

目的探讨慢性肾脏疾病（chronickidneydisease,CKD）1～4期患者血脂代谢异常与血压变异性的相关性。方法入选142例CKD1-4期的患者,将不伴有高脂血症的患者47例设为A组,其中男28例,女19例;伴有高脂血症的患者95例设为B组,其中男56例,女39例。记录2组饮酒史、吸烟史、病程、年龄、性别、身高、体质量、诊所血压,并计算体质量指数。测量空腹时血清总胆固醇（totalcholesterol,TC）、三酰甘油（triglyceride）、低密度脂蛋白胆固醇（10wdensitylipopro—teincholesterol,U）L厂C）、高密度脂蛋白胆固醇（high-densitylipoproteincholesterol,HDL-C）、肌酐、尿酸,对入选的患者进行24h动态血压监测（ambulatorybloodpressure,ABPM）。收集血压参数,将2组血压标准差及变异系数进行对比分析,并将B组的血压变异系数与血脂值进行相关性检验与回归分析,了解血脂异常与CKD患者血压变异性的相关性。结果与A组比较,B组的24h收缩压标准差变异系数和白昼收缩压标准差变异系数增大,差异有统计学意义（P〈0．05）,B组24h收缩压标准差变异系数与TC值呈正相关（r=0．21,P=0．03）,但未能建立回归方程;白昼收缩压标准差变异系数与TC值呈正相关（r=0．19,P=0．04）,但未能建立回归方程;夜间收缩压标准差变异系数与TC值呈正相关（r=0．22,P=0．02）,但未能建立回归方程。结论CKD合并血脂异常较不伴有血脂异常者血压变异性增大,且收缩压血压变异性与TC值呈正相关,提示CKD患者血压变异性与血脂异常之间存在密切的关系,二者联合干预治疗对于减少CKD患者心血管疾病的发生、改善CKD发展和预后具有重要的意义。     

Low-sodium haemodialysis without fluid removal improves blood pressure control in chronic haemodialysis patients

SUMMARY: Hypertension is an important and well‐established risk factor for both cardiovascular and cerebrovascular disease. Hypertension is much more common in patients on renal replacement therapy than in the general population. Up to 80% of patients on renal replacement therapy are hypertensive and about 50% of dialysis patients die from cardiovascular causes. Salt and water overload are major factors exacerbating hypertension in the dialysis population. This was a prospective crossover study of 10 patients examining the effect of haemodialysis for 2 weeks using usual (Na⁺ 138–140 mmol/L) sodium dialysate with a 2‐week period of low (reduced by an average of 5 mmol/L Na⁺ to 133 mmol/L on average) sodium dialysate on inter‐dialytic ambulatory blood pressure (ABPM) and trans‐thoracic bioimpedance (TTB). Ten patients, mean age 67 years, completed the study (two women and eight men). No patient became severely hyponatraemic during the study period. Mean 48 h inter‐dialytic blood pressure (BP) fell from 141/83 to 133/78 (P < 0.01). Mean arterial BP measured immediately prior to TTB fell from 92.8 mmHg to 87.5 mmHg (P < 0.01) during the low‐sodium haemodialysis period. Afterload (systemic vascular resistive index – SVRI) measured by TTB fell significantly during the low‐sodium haemodialysis period (SVRI on Na⁺‐140 = 3426 cf. Na⁺‐134 = 2281; P = 0.01). Dialysate sodium reduction without extra fluid removal had a beneficial effect on inter‐dialytic 48‐h blood pressure in chronic stable haemodialysis patients. Lowering dialysate sodium reduced the systemic vascular resistance index as measured by TTB. Reduction of dialysate sodium was well tolerated, although mild dizzines and cramps did occur. These data suggest that sodium overload and water overload may have independent effects on BP and that simple‐to‐achieve and modest changes in dialysate sodium could usefully augment the action of antihypertensives in dialysis patients.     

慢性肾脏病患者24h动态血压与中医辨证分型的相关性研究

目的探讨慢性肾脏病（chronic kidney disease,CKD）患者动态血压变化与中医辨证分型的相关性。方法收集湖北省中医院符合CKD2～4期诊断标准的门诊及住院患者145例。对入组患者进行24h动态血压监测,根据血压变化情况,分为昼夜平均血压正常组（血压≤130／80mrnHg）,昼夜平均血压升高组（血压≥131／81mmHg）,日间平均血压升高组（血压〉135／85mmHg）,夜间平均血压升高组（血压〉125／75mmHg）;并根据临床表现,对患者进行中医辨证,分为本虚证及邪实证。观察中医各证型在血压正常组和血压升高组中的分布情况。结果①昼夜平均血压正常组的本虚证型分布以脾肾阳虚为主,邪实证型以血瘀证为主;昼夜平均血压升高组的本虚证型以气阴两虚为主,邪实证型以湿浊证为主;②在动态血压从日间升高到夜间升高的过程中,本虚证型中阴阳两虚证型逐渐上升,邪实证型中浊毒证型逐渐上升;③随着24h动态血压升高,本虚证型中,阴阳两虚证型逐渐上升;邪实证型中,浊毒证逐渐上升。结论动态血压变化在一定程度上反映中医正虚邪实的证候变化规律。     

Nighttime Blood Pressure Fall in Renal Disease Patients

Objective.?There are controversial reports in the prevalence of abnormal nighttime blood pressure fall in renal patients. It has been evaluated nocturnal BP in renal patients using 24 h blood pressure monitoring (ABPM) in comparison with nontreated control subjects either normotensives or hypertensives. Design and Methods.?It has been reviewed 137 ABPM studies performed in renal patients (47.8 ± 15.4 years, 76 men and 61 women). The control group includes 119 subjects without kidney disease, 65 were normotensives, and 49 were hypertensives, aged 46.8 ± 12.1 years, 59 men and 60 women. The ambulatory BP was measured noninvasively for 24 h by the SpaceLabs 90207 device programmed to measure BP every 15 min during daytime and every 20 min during nighttime. The definition of daytime and nighttime was made on the basis of wakefulness and sleep or bed rest periods, obtained from a diary kept by each subject. Results.?SBP, but not DBP, was higher (133.9/81.7) in renal disease patients when compared to nonrenal subjects (127.9/80.8, p<0.01). When the control group was split into normotensive and hypertensive patients there were still significant differences, but hypertensives had higher BP than renal disease patients (139.0/89.7, p<0.05). Nocturnal SBP fall in renal disease patients was reduced (5.8%, p<0.001) and so was DBP fall (11.1%, p<0.001) compared with the overall nonrenal patients sample (SBP 10.8; DBP 15.3%). The frequency of nondipper status in renal disease patients (39.6%) was higher than in control patients (18.4%, p<0.001). Nontreated normotensive renal disease patients did not show any difference in either SBP or DBP nighttime fall with respect to control normotensives. Neither do nontreated hypertensive renal patients as compared with control hypertensives. There were not differences between proteinuric and nonproteinuric patients in nocturnal BP fall. The same result was obtained when hypertensive and normotensive nontreated renal patients were compared. The presence of renal failure did not induce a reduction of nocturnal BP fall. Most of treated renal patients were mainly receiving drug therapy during the morning and frequently this was the single daily dose. Conclusions.?Altered diurnal rhythm should not be considered as a usual complication of renal disease. Inadequate antihypertensive pharmacotherapy could be related to the abnormalities of nighttime BP fall when it is detected.     

Salt sensitivity of blood pressure in non-dialysis patients with chronic kidney disease

Background: Chronic kidney disease (CKD) is a world-wide public health problem. Hypertension is both a cause and a complication of CKD, and a risk factor for progression of kidney disease. The effect of salt intake on blood pressure (BP) and the salt sensitivity in non-dialysis patients with CKD were studied. Methods: One hundred and thirty non-dialysis patients with CKD were enrolled in the present study. Daily urinary excretion of sodium (representative of daily sodium intake) and BP was monitored in conditions of original eating habits. Estimated glomerular filtration rate (eGFR) was measured by the creatinine clearance (Ccr). Results: There was a linear positive relationship between the salt intake and systolic blood pressure (SBP) (β?=?0.250, p?=?0.004). It had been found that the log of BP/24-h urinary sodium (salt sensitivity index) had linear relationship with the log of eGFR (β_syst?=??0.364, p?=?0.000, β_diast?=??0.345, p?=?0.000, respectively). Multi-stepwise regression analysis showed SBP was mainly influenced by salt intake and eGFR. There was a negative correlation between diastolic blood pressure (DBP) and age. Conclusion: These results demonstrated a linear relationship between the salt intake and SBP in non-dialysis patients with CKD. The salt sensitivity of BP rose with the decline of renal function.     

Impact of visit-to-visit variability in blood pressure on renal function of stage 3-4 chronic kidney diseases patients with hypertension

Objective To clarify the clinical significance of visit-to-visit variability in blood pressure (BP) of stage 3-4 chronic kidney disease (CKD) patients with hypertension. Methods One hundred and fifty-two cases of stage 3-4 CKD patients with hypertension were enrolled in the study. Variability in BP was defined as the standard deviation (SD) in BP. For each patient, SD and mean BP from BP measurements were calculated at all the visits. Correlations between the decline in estimated glomerular filtration rate (eGFR) and SD in BP were analyzed by multivariable regression. Results Visit-to-visit variability in BP was significantly associated with renal function decline (P＜0.05), in addition, baseline eGFR, baseline albuminuria and mean SBP during follow-up were significantly associated with renal function decline as well (all P＜0.05). The percentage of CCBs used in low SD of the SBP group was higher than that in high SD of the SBP (76.1% vs 58.2%, P＜0.05). Conclusion Visit-to-visit variability in BP is significantly associated with renal function decline. Drugs which can decrease the variability of blood pressure should be the first choice in the treatment of hypertension.     

Immediate blood pressure-lowering effects of aerobic exercise among patients with chronic kidney disease

Aim: The current study was designed to determine the effect of moderate-intensity aerobic exercise on blood pressure responses within the laboratory for 60 min post exercise and in the subsequent 24 h period in patients with chronic kidney disease. Methods: Twenty-four subjects with stages 2–4 chronic kidney disease (age = 54.5 ± 15.2 years, body mass index = 32.0 ± 5.9 kg/m²) on antihypertensive medication completed this study. In random counterbalanced order, subjects were asked to either walk for 40 min at 50–60% VO_2peak (oxygen consumption) or, on a separate day, to sit quietly in the laboratory for the same length of time. Following exercise or the non-exercise period, blood pressure was taken at 10 min intervals for 60 min. Subjects then wore an ambulatory blood pressure monitor for the next 24 h. Results: Systolic blood pressure (mmHg) was reduced by 6.5 ± 10.8 compared with the pre-exercise baseline value (130.3 ± 21.1) in the laboratory after exercise and this was greater than after the control period (0.73 ± 10.3, P < 0.05). Diastolic blood pressure (mmHg) was reduced following exercise (2.5 ± 6.4) compared with the control period (2.1 ± 4.9, P < 0.05). The mean 24 h readings did not differ between exercise or non-exercise days. Conclusion: Acute aerobic exercise leads to reduced blood pressure for at least 60 min within the laboratory in chronic kidney disease patients.     

慢性肾脏病患者血压变异性与肾功能损伤关系的研究

目的研究不同肾功能水平的慢性肾脏病(chronic kidney disease,CKD)患者24 h动态血压特点,探讨血压变异性与肾功能损伤之间的关系。方法选择上海交通大学附属瑞金医院肾脏科的CKD住院患者509例,收集并记录患者的基本信息、实验室检查数据,采用携带式动态血压检测仪监测患者24 h动态血压参数,采用GEVivid7彩色超声心动图检查仪记录患者左心室质量指数(left ventricular mass index,LVMI)参数。采用SPSS 15.0统计软件进行数据统计分析。结果本研究共纳入CKD患者509例,其中CKD 1期102例(占20.0%),CKD2期107例(占21.0%),CKD3期114例(占22.4%),CKD4期97例(占19.1%),CKD 5期89例(占17.5%)。随着CKD患者肾功能水平的下降,患者的24 h平均收缩压逐渐升高(P0.05),而24 h平均舒张压的改变无统计学差异(P0.05)。CKD 4期和5期患者的白昼平均收缩压、夜间平均收缩压、夜间平均舒张压明显高于CKD 1~3期患者(P0.05),而白昼平均舒张压的差异则无统计学意义。CKD 4期和5期患者的24 h收缩压标准差(24 h systolic standard deviation,24hSSD)、白天收缩压标准差(day systolic standard deviation,dSSD)、夜间收缩压标准差(night systolic standard deviation,nSSD)明显高于CKD 1~3期患者(P0.05),而24 h舒张压标准差(24 h diastolic standard deviation,24hDSD)、白天舒张压标准差(day diastolic standard deviation,dDSD)、夜间舒张压标准差(night diastolic standard deviation,nDSD)则无统计学差异(P0.05)。CKD患者非杓型血压的比例随肾功能下降逐渐升高,CKD 1期患者的非杓型血压比例为54.1%,而CKD 5期患者的非杓型血压比例甚至高达85.6%。LVMI异常的CKD患者的24hSSD及dSSD高于LVMI正常的CKD患者(P0.05),而nDSD,nSSD,dDSD,24hDSD的差异无统计学意义。结论随着CKD患者肾功能下降及平均血压水平升高,血压变异性增加,血压昼夜节律减退,非杓型血压比例增加。控制血压水平及调整血压昼夜节律对CKD患者的治疗具有重要意义。     

Clinical and pathological significance of circadian blood pressure rhythm change in IgA nephropathy patients with hypertension

Objective To investigate whether the clinical and pathological injury of kidney in IgA nephropathy (IgAN) patients with hypertension is associated with circadian blood pressure rhythm change, particularly with elevated nocturnal blood pressure (BP). Methods This study was a retrospective cross-sectional study. Clinic and renal histopathological injury data were obtained from 83 IgAN patients with hypertension. First, 24 h ambulatory BP monitoring (ABPM) data were analyzed. Second, all these IgAN patients were divided into two groups, elevated nocturnal BP group and nocturnal normotensive BP group, and the clinical and pathological differences between this two groups were analyzed. Third, logistic regression analysis was used to analyze the influencing factors of renal tubulointerstitial injury in IgAN patients with hypertension. At last, all these IgAN patients were divided into two groups according to the level of estimated glomerular filtration rate (eGFR), group of patients with eGFR≥60 ml?min-1?(1.73 m2)-1 and the other group with eGFR＜60 ml?min-1?(1.73 m2)-1, and the 24 h ABPM data were compared. Results (1) The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension was 79.5%. (2) Compared with nocturnal normotensive BP group, patients in elevated nocturnal BP group had significantly higher levels of 24-hour urinary protein quantity and blood uric acid (both P＜0.05), and lower eGFR and urine osmotic pressure clinically (both P＜0.05). Index of interstitial fibrosis and tubular atrophy was significantly higher in nocturnal normotensive BP group (P＜0.05), while the proportion of glomerular ischemia lesion was not significantly different between two groups. (3) Multivariate logistic regression analysis showed that elevated nocturnal BP was an independent risk factor for severe tubulointerstitial injury of IgAN (OR=1.113, 95%CI 1.038-1.192, P=0.002). (4) Compared with the group of eGFR≥60 ml?min-1?(1.73 m2)-1, 24-hour systolic blood pressure (SBP) and diastolic blood pressure (DBP), daytime SBP and DBP, nocturnal SBP and DBP were significantly higher in group of eGFR＜60 ml?min-1?(1.73 m2)-1 (all P＜0.05). Conclusion The proportion of non-dipper circadian rhythm of BP in IgAN patients with hypertension is as high as 79.5%. Elevated nocturnal BP is associated with the severity of renal damage, and elevated nocturnal BP is an independent risk factor for severe tubulointerstitial injury in IgAN patients with hypertension. Therefore, 24 h ABPM should be emphasized, and elevated nocturnal BP should be well controlled to slow the progression of IgAN.     

Twenty-four-hour ambulatory blood pressure monitoring in infants and toddlers

During the past several years, 24-hour (24-h) ambulatory blood pressure monitoring (ABPM) has become a useful tool for the diagnosis and management of children and adolescents with elevated blood pressure (BP). Some reports have also provided blood pressure nomograms for particular devices. However, there are very few reports of the use of this method in very young children. In our study we investigated the applicability of ABPM in 97 healthy infants and toddlers, aged from 2 to 30 months. A satisfactory ABPM profile was obtained in 86.6% of the children, with an average of 75.0% satisfactory BP recordings. The mean ± SD systolic and diastolic BP of healthy infants and toddlers was 99±12/62±12 mmHg during the daytime and 95±11/57±10 mmHg during the night, with no gender difference being observed. The 24-h mean ± SD systolic and diastolic BP, which may be a more appropriate measure of BP in this particular age group, was found to be 97±12/59±11 mmHg. We also confirmed the increase in systolic and diastolic BP with increased height (length). There was only a slight nocturnal decrease in BP. We conclude that this method is applicable for the assessment of blood pressure in very young children.     

Interdialysis blood pressure control by long haemodialysis sessions

High blood pressure (BP) is a major factor contributing to thehigh incidence of cardiovascular morbidity and mortality inhaemodialysis (HD) patients. According to predialysis casualBP measurements, long HD has been shown to provide good BP control. To confirm this result during the period between dialysis sessions,we performed ambulatory monitoring of BP in 91 non-selectedHD patients (mean age, 58.7 (14.1) years; 14% incidence of nephrosclerosisand diabetes mellitus; treatment duration, 93.0 (77.2) months;3x8 h/week, cuprophane, acetate buffer in 95% of the patients).Only one patient (1.1%) was receiving an antihypertensive medication. Ambulatory BP results were systolic (S) BP, 119.4 (19.9) mmHg;diastolic (D) BP, 70.6 (12.9) mmHg; mean (M) BP, 87.6 (13.9)mmHg. These values were significantly lower than the casualpredialysis BP data and close to the reference values reportedby Staessen et al. in a meta-analysis including 3476 normotensivesubjects. The MBP was inversely correlated with the treatmentduration, but not with interdialysis weight gain. The MBP increasedsignificantly in the last part of the interdialysis period,and this rise was not correlated with the interdialysis weightgain. The nocturnal/diurnal ratios for SBP and DBP for the HDpatients (0.97 and 0.92) were higher than the reference valuesreported by Staessen, (0.87 and 0.83), and argued against anocturnal decrease in BP. We found that 52.1% of the patientshad an abnormal nocturnal BP fall (MBP fall <5%). This featureworsened during the second night of the interdialysis period. We confirm that interdialysis BP in HD patients treated by longHD and without antihypertensive drugs approached the levelsobserved in a normal population. Achievement of dry weight isthought to be the cornerstone of this good result, but we cannotrule out other mechanisms such as the optimal clearance of pressormolecules. The BP rise during the interdialysis period, independentof the weight gain, argues for such an accumulation. Despitegood BP control the circadian rhythm of BP is not restored inour patients, and remains to be studied.