Changes Of Circadian Rhythm Of Blood Pressure And Its TCM Syndromes In Patients With Chronic Kidney Disease

The chronic kidney disease (CKD) is a group of progressive disease which threatens the human’s life and health seriously, its continued progress eventually lead to uremia. The recent years researches indicate that, the abnormal circadian variation of blood pressure, of which non-dipper blood pressure pattern is a representative, is another independence dangerous factor of the progression of CKD except for hypertension and albuminuria. Therefore, to find the method to improve the blood pressure rhythm, and to make it back to the normal dipper blood pressure pattern has become a hot topic between modern and traditional medical scientists. Through the earlier research work, we have found that the patients on CKD1-2 stage have already got the abnormal blood pressure pattern before their BP level elevated. This kind of change will have a disadvantageous influence on the patients’kidney function. But the medicine treatments, which are confirmed by the modern medical science that could be used to improve the blood pressure circadian variation, still rarely can be accepted by the patients. This research aims at finding the pathogenesis of the disorder of the circadian rhythm of blood pressure, depending on the theories of treatment according to syndrome differentiation and midnight-midday ebb flow.This paper consists of two parts. First is a summary of documents, and the second part is a clinical steady.The documents summary firstly made an introduction of the Ambulatory Blood Pressure Monitoring (ABPM) and its applications. Then elaborated the research progress of modern medicine on the abnormal circadian variation of blood pressure, and the understanding of traditional Chinese medicine on this issue.The modern medicine believed that, many nerves and endocrine factors participated in the production and the maintenance of the blood pressure circadian variation, mainly including the suprachiasmatic nucleus, the sympathetic and parasympathetic nervous system, melatonin, vascular endothelial system function, rennin-angiotensin-aldosterone system activeness, the plasma catecholamine level, the hemodynamics change and the sleep disorders, and so on. If any of the above factors occur, it may cause the non-dipper blood pressure pattern, thus causes the blood vessel, the heart, the kidney and other important internal organs to go wrong on structure and the function, which could increase the risk of cardiovascular and cerebrovascular events. The traditional Chinese medicine had no concept of blood pressure and its day and night rhythm, but it had already known the biorhythms of life and the relationship between the biorhythms and the natural law. Inspired by the ancient Chinese medicine, nowadays doctors of traditional Chinese medicine studied the etiology and pathogenesis of abnormal blood pressure circadian rhythm from three aspects. The first is the yin and yang theory, the TCM syndrome differentiation theory and the midnight-midday ebb flow theory.Finally the summary of documents elaborated the relationship between the abnormal blood pressure circadian rhythm and CKD. Because of a series of pathology changes, the CKD patients, compared with the normal crowd, have a higher rate of the non-dipper blood pressure patterns. At the same time, the non-dipper blood pressure can further accelerate the CKD progress, and that forms a vicious circle.The clinical research part carries on 24hABPM to 35 CKD1-2 stage patients without hypertension and 23 normal people, and according to the midnight-midday ebb flow theory, it tried to compare the 24hABPM data deploys with the 12 two-hour periods of the day and the 12 internal organs. And at the same time carried on Chinese medicine card period of five days grading to 35 CKD patients, and analyzed the relationship between the TCM syndrome and 24hABPM data. Results:1.The CKD group had a higher level for mean BP of the entire day, daytime and night time. And the difference in mean diastolic BP of night time has statistics significance (P< 0.05).2. Group of CKD systolic BP circadian decline rate is less than 10%, is a typical non-dipper type change, the difference is statistically significant (P> 0.05). Compare with the normal control, the CKD group had a lower BP circadian decline rate, but the difference had no statistics significance (P> 0.05).3. The rate of non-dipper BP pattern among the CKD patients is 68.6%, and that among the normal control is 39.1%, the two data had a significant difference (P< 0.05).4. According to the hour will be divided into five different times at night, found that systolic BP and diastolic BP in CKD group were higher than that of normal control group, and between HaiShi diastolic BP difference is statistically significant (P< 0.05). But in other times and HaiShi systolic BP, there were no statistically significant difference between the two groups (P> 0.05).5. The CKD group is divided into dipper and non-dipper BP groups, compared and found that there were no statistically significant differences in the length of disease course and GFR between the two groups.6. The non-dipper BP group had a higher plasma urea nitrogen level than the dipper BP group, statistically significant difference (P< 0.05). But the serum creatinine, 24 hours urinary protein quantitative, plasma renin activity and plasma angiotensin were of no statistically significant difference between the two groups (P> 0.05).7. The common TCM syndromes among patients on CKD1-2 stage was:kidney deficiency, compared with lung deficiency syndrome and liver deficiency syndrome difference was statistically significant (P< 0.05), there was no statistically significant difference compared with spleen deficiency (P> 0.01). The incidence of Xue deficiency syndrome was lower than, Yang deficiency syndrome, qi deficiency syndrome, and Yin deficiency syndrome, the difference was statistically significant (P< 0.01). The last three syndromes were of no statistically significant difference (P> 0.01).8. The common TCM syndrome of non-dipper CKD group are kidney deficiency (63.64%), Qi deficiency (54.55%), Yang deficiency (54.55%); The common TCM syndrome of dipper CKD were kidney deficiency (75.00%), Yang deficiency (66.67%), Yin deficiency syndrome (51.43%) and spleen deficiency (50%). But all type of syndromes between two groups had no statistical significance (P> 0.05).9. The common TCM syndrome among reverse-dipper CKD patients was:Kidney deficiency (100.00%), Yang deficiency syndrome (100%). And the common TCM syndrome among CKD patients except for reverse-dipper individuals was:Kidney deficiency (64.29%), deficiency syndrome (53.57%), Yin deficiency syndrome (53.57%), Yang deficiency syndrome (53.57%). The reverse-dipper CKD patients had a higher occurrence rate of Yang deficiency than the rest individuals, the difference was statistically significant (P< 0.05). Conclusion:1. Before the clinical hypertension, the early CKD patients had already got nighttime BP increase and the non-dipper BP pattern. The incidence of non-dipper BP pattern is higher in early CKD patients without hypertension than in normal people.2. The abnormal blood pressure pattern of the early CKD patients can affect both systolic and diastolic blood pressure.3. The CKD group had a significant difference compared with normal control on HaiShi diastolic BP, according to the midnight-midday ebb flow theory, the dysfunction of Shaoyang and triple energizer may be plays a role on the appearance of non-dipper BP pattern.4. The common TCM syndromes among early CKD patients were:kidney deficiency, spleen deficiency, Yang deficiency, Qi deficiency and Yin deficiency. The excess syndromes are relatively rare. The non-dipper and dipper CKD patients had no significant differences in TCM syndrome. Yang deficiency is more common in CKD patients with reverse-dipper BP pattern.5. In early CKD patients, the pathogenesis of TCM of abnormal blood pressure circadian rhythm may be kidney deficiency, disorder of Shaoyang function and Qi movement, and Yin-Yang disharmony. It provides a new train of thought for the Chinese medicine to play a role in slow CKD progress.