慢性肾脏病合并顽固性高血压患者动态血压监测结果分析

目的了解动态血压监测（ABPM）在慢性肾脏病（CKD）患者合并顽固性高血压诊疗中的应用价值。方法回顾性收集本院2006年1月至2008年6月81例CKD合并顽固性高血压患者调整降压治疗至少两周后的临床资料，药物治疗情况，诊室血压（CBP）及ABPM资料并分析。根据每日限定剂量数（DDD）计算方法量化患者每日降压药物量。ABPM采用携带式血压监测仪（Mobil-0GRAPH S／N B03441）完成，应用Hypertension Management Softwarefor Windows进行数据分析。结果根据24小时平均血压与CBP测定结果比较，12．4％（10／81）的患者表现为隐性高血压；8．6％（7／81）的患者有白大衣性高血压。在均有夜间降压药物治疗的基础上，91．4％（74／81）的患者存在血压节律异常；夜间收缩压和舒张压负荷均高于白天。该组患者利尿剂使用率仅19．8％，显著低于其他种类降压药。结论ABPM能为CKD合并顽固性高血压患者血压控制水平的判断及节律观察提供重要信息。

Analysis of ambulatory blood pressure monitoring data of chronic kidney disease patients with refractory hypertension

Objective To evaluate the value of 24-hour ambulatory blood pressure monitoring （ABPM） in treatment of chronic kidney disease （CKD） patients with refractory hypertension. Methods Clinical data, antihypertension regimen, clinic blood pressure （CBP） value and ABPM data of 81 CKD patients with refractory hypertension who had been treated for at least two weeks were retrospectively collected and analyzed since Jan 2006 Jun 2008 in the First Hospital of Peking University. Defined daily dosage（DDD） method was adopted to quantificate the anti-hypertension drugs. ABPM was performed with a portable oscillometric recorder（Mobil-O-GRAPH S/N B03441）. Hypertension Management Software for Windows was used to analyze the 24-hour data. Results According to the comparison of CBP and ABPM results, 12.4% （ 10/81 ） patients were deemed as mask hypertension, while 8.6%（ 7/81） were as white coat hypertension. 91.4% （74/81） patients were deemed as non-dippers. Both SBP load and DBP load of night were higher than those of daytime. Diuretics were only adopted in 19.8% patients, which was far below than other anti-hypertension drugs. Conclusion ABPM can provide useful information in the evaluation of blood pressure level and rhythm in the treatment of CKD patients with refractory hypertension.