Study On Blood Pressure Variability And Its Risk Factors In Patients With Chronic Kidney Disease And Hypertension

Object:This study aims to analyze the trend of ambulatory blood pressure and blood pressure variability along with the increasing of chronic kidney disease(CKD),compare the general data and clinical data,investigate the relationship between blood pressure variability and renal function,and study the risk factors affecting blood pressure variability relationship in patients with CKD and hypertension.Methods:A retrospective analysis was performed in 156 patients with CKD and hypertension in our hospital from August 2014 to March 2018,and all of the patients received 24-hour ambulatory blood pressure monitoring(24hABPM).In the first section,based on the glomerular filtration rate(eGFR),the patients were divided into CKD stage 1,CKD stage 2,CKD stage 3,CKD stage 4,and CKD stage 5,respectively.We compared the 24 hABPM numerical value and the quantitative indicators of blood pressure variability,such as the coefficient of the variation of blood pressure among different groups.In the second section,according to the variation pattern of blood pressure in patients with CKD and hypertension,the patients were divided into the group of normal blood pressure circadian rhythm and the abnormal blood pressure circadian rhythm.By analyzing the general data of these two groups,such as gender,age,related complications,BMI,hemoglobin,blood lipids,GFR,serum creatinine,blood urea nitrogen,parathyroid hormone,blood uric acid,and 24-hour urine protein quantitation,to further determine the risk factors affecting blood pressure circadian rhythm in patients with CKD and hypertension.The data were analyzed using SPSS 22.0.Statistical difference was defined as P < 0.05.Results:1.With the increasing of CKD stage,the 24-hour mean systolic blood pressure,the mean daytime systolic blood pressure,and the mean nighttime systolic blood pressure gradually increased,and the difference of these three values was statistically significant among different CKD groups(P<0.05).There was no significant difference in 24-hour mean diastolic blood pressure,the mean daytime systolic blood pressure,and the mean nighttime systolic blood pressure among different CKD groups(P>0.05).2.With the increasing of CKD stage,the variation coefficient of 24-hour systolic blood pressure and the variation coefficient of daytime systolic blood pressure significantly increased in patients of different CKD stages,and the difference was statistically significant among different groups(P<0.05).There was no statistical difference in the variation coefficient of 24-hour diastolic blood pressure,the variation coefficient of daytime diastolic blood pressure,the variation coefficient of nighttime systolic blood pressure,and the variation coefficient of nighttime diastolic blood pressure among different CKD stages(P>0.05).3.Among the 156 patients with CKD and hypertension,26 patients(26/156,16.67%)presented with normal blood pressure circadian rhythm(dipper blood pressure),130 patients(130/156,83.33%)presented with abnormal blood pressure circadian rhythm,including 9 patients(9/156,5.77%)with extreme dipper blood pressure,75 patients(75/156,48.08%)with non-dipper blood pressure,and 46 patients(46/156,29.49%)with reverse blood pressure.There were 20 cases(20/130,15.4%)with abnormal circadian rhythm in CKD stage 1,23 cases(23/130,17.7%)in CKD stage 2,28 cases(28/130,21.5%)in CKD stage 3,29 cases(29/130,22.3%)in CKD stage 4,and 30 cases(30/130,23.1%)in CKD stage 5.With the increasing of CKD stage,the proportion of patients with blood pressure variation who belong to the abnormal blood pressure circadian rhythm type gradually increased(P<0.05).4.Compared with the normal blood pressure circadian rhythm group,the proportion of patients with CKD and diabetes in the abnormal blood pressure circadian rhythm group was higher(P<0.05).There was no statistical difference between the two groups in CKD patients with cardiovascular disease and cerebrovascular disease(P>0.05).5.Compared with the normal blood pressure circadian rhythm group,the eGFR,hemoglobin,and serum calcium were significantly lower(P<0.05),while the level of blood uric acid,triglyceride,24-hour urine protein,and parathyroid hormone were statistically higher(P<0.05)in CKD patients with abnormal blood pressure circadian rhythm.There was no statistical difference in the data of gender,age,BMI,serum creatinine,blood urea nitrogen,albumin,serum phosphorus,total cholesterol,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and blood glucose between the two groups(P>0.05).Based on the single factor logistic regression analysis,the levels of eGFR,diabetes mellitus,serum uric acid,triglyceride,24-hour urine protein quantitation,and parathyroid hormone were related with the abnormal blood pressure circadian rhythm in CKD patients(P<0.05).According to the multi-factor logistic regression analysis,the 24-hour urine protein quantitation(OR=2.045,95% CI: 1.209~3.460,P=0.008)and parathyroid hormone(OR=1.019,95% CI: 1.060~1.022,P=0.001)were two independent risk factors of the abnormal blood pressure circadian rhythm in CKD patients.Conclusion:1.With the increasing of CKD stage,the proportion of patients with blood pressure variation in the abnormal blood pressure circadian rhythm group gradually increased,and the proportion of non-dipper blood pressure type was the highest in patients with abnormal blood pressure circadian rhythm.2.There was close relationship between the renal function and the 24-hour mean systolic blood pressure,daytime mean systolic blood pressure,nighttime mean systolic blood pressure,24-hour systolic blood pressure BPV,and daytime systolic blood pressure BPV in patients with CKD and hypertension.3.Compared with the patients with normal blood pressure circadian rhythm,the renal function decreased more significantly,and the lipid metabolism,anemia,calcium and phosphorus metabolism were more serious in CKD patients with hypertension.In addition,and the proportion of CKD patients with diabetes was higher than those with normal blood pressure circadian rhythm.4.The increased urine protein levels and PTH levels were two independent risk factors for the blood pressure variation in CKD patients.