Morning Blood Pressure Surge With Clinicopathological Characteristics In Patients With IgA Nephropathy

Objective:To investigate the relationship between morning blood pressure surge and clinicopathological manifestations in patients with IgA nephropathy with or without morning blood pressure surge.Methods:A cross-sectional observational study was conducted.Patients who was diagnosed as primary IgA nephropathy in General Hospital of Ningxia Medical University during January 2015 to November 2016 were enrolled.All the patients were divided into two groups:morning surge group(≥35mmHg)and non-morning surge group(<35mmHg)according to the definition of morning blood pressure surge(MBPS)in 2010 guideline of hypertension in China[5].Comparisons were made on the patient’ s basic information,hi story of hypertension,the results of the data on cl inicopathotogicat characteristics,24 hour ambulatory blood pressure monitoring(ABPM)and ultrasonographic assessment.Results:① A total of 113 IgA nephropathy patients with mean age of 37.48 ± 10.69 years were enrolled in the study,including 60(53.1%)cases of male and 53(46.9%)of females.There were 66(58.4%)IgAN patients with abnormal morning blood pressure surge and 47(41.6%)IgAN patients with normal morning blood pressure surge.In the non-MBPS group with average age of 36.38 ± 10.13 years,18 patients(38.3%)were male and mean BMI was(23.21 ±3.35)kg/m2.Among the patients,18 cases(38.3%)had hypertension history and were treated with antihypertensive drugs,mainly to ACEI.There were only 2 patients who took double anti-hypertensive drugs.In the MBPS group with average age of 38.26± 11.08 years,42 cases(63.6%)were male and the mean BMI was 24.86± 3.44 kg/m2.Among the patients,39 cases(59.1%)had hypentension history.There were 37(56.1%)cases who were treated with antihypertensive drugs,mainly to CCB.There were 13 patients with double antihypertensive drugs.② Compared to the non-MBPS group,the proportion of male patients in the MBPS group was higher(P<0.05).The serum creatinine and 24-hour urinary protein showed an increasing trend and the eGFR showed a decreasing trend in MBPS group,but there were no statistically significant(p>0.05).The level of triglyceride,LVMI,LVPW,LVDd and IVST were significantly increased in MBP group(P<0.05).③ IgA nephropathy patients with abnormal BP rhythms accounted for 69.0%(78/113).Compared to the non-MBPS group,the incidence of circadian rhythm abnormality was higher in MBPS group(P<0.05).Mo。t patients in two groups had a non-dipper blood pressure.Compared to the non-MBPS group,the average dSBP and the variation of morning blood pressure surge in MBPS patients was significantly increased(P<0.05).④Pathological changes showed that the sclerosis and mesangial hypercellularity,endocapillary hypercellularity,and interstitial inflammatory cell infiltration were much more severe in the MBPS group than the non-MBPS group(P<0.05).⑤ The mesangial hypercellulari ty and endocapillary hypercellularity were independently associated with MBPS in IgAN patients by multivariate Logistic regression analysing(P<0.05).Conclusion:The incidence of abnormal blood pressure of IgAN patients was 58.4%.Patients with MBPS had higher BMI、triglyceride,LVMI,and renal disease pathological changes.Mesangial hypercellularty and endocapillary hypercellularity were independently associated with MBPS.