肾脏局部肾素-血管紧张素系统与血压昼夜节律的关系研究

目的 探讨肾脏局部肾素-血管紧张素系统(RAS)是否存在昼夜节律,及其与血压昼夜节律的关系.方法 选择2018年3月至2019年3月在河北省人民医院就诊的原发性高血压(EH)患者104例,其血清肌酐(SCr)与估算的肾小球滤过率(eGFR)均正常.根据收缩压的昼夜节律类型,将患者分为杓型组37例、非杓型组35例和反杓型...

Relationship between intrarenal renin-angiotensin system and circadian rhythm of blood pressure

Objective To investigate whether there is a circadian rhythm in the intrarenal reninangiotensin system,and its relation to the circadian rhythm of blood pressure.Methods From March 2018 to March 2019,104 patients with essential hypertension(EH)were admitted to the Hebei General Hospital,and the serum creatinine level and estimated glomerular filtration rate were normal.The patients were divided into dipper group(n=37),non-dipper group(n=35)and reverse dipper group(n=32),according to circadian rhythm of systolic blood pressure.Urinary renin(U-REN)and urinary angiotensinogen(U-AGT)were measured in each group at four time periods respectively(8:00-14:00,14:00-20:00,20:00-2:00,2:00-8:00 the next day).Results(1)The level of U-REN was higher in reverse dipper group and non-dipper group than that in dipper group at 20:00-2:00 and 2:00-8:00 periods(all P<0.05),and reverse dipper group was significantly higher than non-dipper group(all P<0.05).(2)The level of U-AGT was higher in reverse dipper group and non-dipper group than that in dipper group at 14:00-20:00,20:00-2:00 and 2:00-8:00 periods(all P<0.05),and reverse dipper group was higher than non-dipper group at 20:00-2:00 and 2:00-8:00 periods(all P<0.05).(3)There was no significant difference of U-REN and U-AGT in dipper group at each time period(all P>0.05).It was noted that U-REN and U-AGT in non-dipper group and reverse dipper group at 20:00-2:00 and 2:00-8:00 periods were significantly higher than those at 8:00-14:00 and 14:00-20:00 periods(all P<0.05).U-REN and U-AGT were especially higher in reverse dipper group(all P<0.05).Conclusions U-REN and U-AGT show circadian rhythms in reverse dipper group and non-dipper group,and the levels during nighttime are significantly higher than those during daytime.The intrarenal renin and angiotensinogen levels have no obvious circadian rhythm in dipper group.The measurement of U-REN and U-AGT during daytime and nocturnal urine may help to determine the degree of the intrarenal renin-angiotensin system activation and to further understand the extent of impaired blood pressure rhythm.