| Objective To evaluate the role of ambulatory blood pressure monitoring (ABPM) in diagnosing circadian rhythm of Chronic Kidney Disease (CKD) with hypertensive patients; To assess the efficacy of evening dosing of antihypertensive drugs in CKD with hypertensive patients.Methods1. We enrolled222hypertensive patients with or without CKD in our hospital from July2012to September2013. General information and blood pressure from all the patients were recorded. We enrolled hypertensive patients with or without CKD in our hospital during2012.7-2013.9.2. In an open-label uncontrolled trial, we assigned155CKD with hypertensive patients either to take all prescribed hypertension medications in the morning or to take at least one of them at night. We measured24-hour ambulatory blood pressure (BP) at baseline and8weeks after treatment.3. A comprehensive search of Medline, Embase, Chinese Biomedical Literature Database and the Cochrane Central Register of Controlled Trials was performed in August2013. Randomized controlled or crossover trials designed to evaluate the effects of evening vs. morning dosing of antihypertensive drugs regimen on clinical outcomes in CKD patients with hypertension were collected. All statistical analysis were calculated using the RevMan5.1software from the Cochrane Collaboration.Results1. With the deterioration of renal function, BP increased, and the rate of dipping BP patterns deceased. Multiple linear regression analysis revealed that renal dysfunction, fat, and male were associated with increase of nighttime BP. The ambulatory BP was higher than office BP in moderate and severe renal dysfunction (CKD stage3-5) patients (P<0.001). Compared with the difference between office systolic BP and24h average systolic BP or between office systolic BP and daytime average systolic BP, the difference between office systolic BP and nighttime average systolic BP was higher (4.90±14.72vs.2.63±14.76vs.10.35±16.76, respectively, P＜0.001)2. There were23.30%hypertensive patients complicated with isolated ambulatory hypertension, and81.13%isolated ambulatory hypertension complicated with non-dipping or reverse dipping status. There was21.62%hypertensive patients complicated with isolated nocturnal hypertension (INH). After adjusting age, gender, and BMI, eGFR was associated with the incidence rate of INH(OR=0.972,95%CI:0.954-0.991)3. After8weeks of treatment, there was no difference between two groups in CKD with hypertensive patients. However, CKD with INH treated with nighttime doses of antihypertensive drug showed a greater reduction in24h average systolic BP (P-0.045),24h average diastolic BP(P=0.021), daytime average systolic BP(P=0.035), nighttime average systolic BP (P=0.036), nighttime average diastolic BP (P=0.019). After adjusting eGFR, the difference in the reduction of nighttime average diastolic BP between two groups was still statistically significant.4. Three trials involving737patients were identified and only one trial that studied661patients reported all cause mortality and cardiovascular outcomes. There is limited evidence from one randomized controlled trial that patients who took at least one antihypertensive medication at bedtime could not reduced total death (P=0.056) or cardiovascular death (P=0.059); but reduced total events (P＜0.001) and major cardiovascular events (P<0.001). Comparing with morning dosingregimen, taking antihypertensive drugs in the evening significantly lowered the nighttime systolic blood pressure (SBP) by5.88mmHg (95%CI3.16to8.59, P＜0.0001) and diastolic blood pressure (DBP) by2.49mmHg (95%CI0.84to4.14, P=0.003).Conclusion1. It’s essential for CKD with hypertensive patients or isolated ambulatory hypertensive patients to take ABPM as a supplementary diagnosing instrument.2. Regimen of taking regular antihypertensive drugs in the evening should be considered for CKD with hypertension patients to lower the nighttime blood pressure and help preventing total events and cardiovascular mortality. |
PDF Full Text Request