慢性肾脏病患者血压形态特点及临床疗效分析

目的 研究慢性肾脏病（chronic kidney disease，CKD）患者血压形态特点，以及睡前服用降压药对患者临床疗效影响。方法 2018年1月至2019年9月住院的182例CKD合并高血压患者的动态血压数据和临床指标，描述患者的血压昼夜节律特点和特殊血压类型分布。分析睡前服用降压药对患者临床疗效影响。结果 不同CKD分期患者的年龄、24 h收缩压、白天收缩压、夜间收缩压差异有统计学意义。CKD合并高血压患者血压形态以非杓型为主。与杓型血压组患者比较，非杓型或反杓型患者的年龄、超敏C反应蛋白（hypersensitive C reactiveprotein，hs CRP）偏高，血红蛋白偏低（P＜0.05）；多因素回归分析显示年龄、hs CRP是发生异常血压节律的独立危险因素。患者的诊室血压控制率25.3%，动态血压控制率14.3%，均控制率5.5%，夜间血压未控制率83.5%。19.8%的患者有隐匿性高血压，8.8%的患者有白大衣性高血压。将降压药改为睡前服用的患者3个月后的24 h尿蛋白和血尿酸显著改善（P＜0.05）。结论 CKD合并高血压患者的血压形态以非杓型为主。年龄、hs CRP是发生血压节律异常的独立危险因素，血红蛋白越低的患者更容易发生非杓型血压。睡前服用降压药可能通过恢复血压昼夜节律来减少尿蛋白及降低血尿酸。

Analysis of blood pressure morphology and clinical effect in patients with chronic renal disease

Objective To study the morphological characteristics of blood pressure in patients with chronic kidney disease (CKD) and the clinical effect of antihypertensive drugs before bedtime on patients. Methods The dynamic blood pressure data and clinical indicators of 182 CKD patients with hypertension who were hospitalized from January 2018 to September 2019 were collected to describe the characteristics of patients blood pressure circadian rhythm and the distribution of special blood pressure types. The clinical effect of taking antihypertensive drugs before bedtime on patients were analyzed. Results There were significant differences in age, 24 hour systolic blood pressure, daytime systolic blood pressure and night systolic blood pressure among patients with different CKD stages. The pattern of blood pressure in CKD patients with hypertension was mainly non dipper. Compared with the patients in dipper type blood pressure group, the patients with non dipper or anti dipper had higher age, higher hypersensitive C reactive protein (HS CRP) and lower hemoglobin. Multivariate regression analysis showed that age and HS CRP were independent risk factors for abnormal blood pressure rhythm. The blood pressure control rate of the patients in the clinic was 25.3%, the dynamic blood pressure control rate was 14.3%, the average control rate was 5.5%, and the uncontrolled blood pressure rate at night was 83.5%. 19.8% of the patients had masked hypertension, and white coat hypertension was found in 8.8% of the patients. The 24 hour urine protein and serum uric acid were significantly improved in patients who took antihypertensive drugs before going to bed for three months (P<0.05). Conclusion The main pattern of blood pressure in patients with CKD complicated with hypertension is non dipper. Age and HS CRP are independent risk factors for abnormal blood pressure rhythm. Patients with lower hemoglobin are more likely to develop non dipper blood pressure. Taking antihypertensive drugs before bedtime may reduce urine protein and serum uric acid by restoring the circadian rhythm of blood pressure.