Correlation Between Morning Blood Pressure Surge And Prognosis Of Chronic Kidney Disease

Objective:To study the prognostic value of morning blood pressure surge in chronic kidney disease.Methods:Retrospective cohort study.A total of 153 patients with CKD diagnosed in the department of nephrology of general hospital of ningxia medical university on January 1,2012 and December 31,2017 were selected.All patients met the following conditions: age 18 years old;complete 24 h dynamic blood pressure monitoring;and regular follow-up for more than 1 year.Demographic data,baseline laboratory data and follow-up data were collected.According to the morning peak blood pressure level,the patients were divided into two groups(namely morning peak blood pressure increasing group 35 mmHg and non-morning peak blood pressure increasing group < 35mmHg),and the clinical characteristics of the two groups were compared.The end points of the study were all-cause death,end-stage renal disease and cardiovascular and cerebrovascular disease.Kaplan-meier method and Cox regression model were used to analyze the relationship between morning peak blood pressure and endpoint events.Results:1.153 patients with CKD were included in this study,including 87 males and 66 females.The average age was(51.8±14.4)years.Morning peak blood pressure increased group of 50 cases;Non-morning peak blood pressure increased group of 103 cases.The longest follow-up time was 6.7 years,and the average follow-up time was 4.25 years.2.Comparing the clinical characteristics of patients in the two groups,it was found that compared with thenon-morning peak hypertension group,patients in the morning peak hypertension group had a higher incidence of IgA nephropathy and hypertension,with increased levels of BMI,serum creatinine,24 hSBP,dSBP,dDBP,24 hPP and dPP,while decreased levels of HDL.3.Patients with CKD were divided into the terminal event group and the non-terminal event group according to whether terminal events occurred.Compared with the two groups,it was found that patients in the terminal event group had significantly higher levels of urea,serum phosphorus,serum creatinine,24 h urine protein,ventricular septal thickness,left ventricular posterior wall thickness,left ventricular end-diastolic diameter,LVMI,and lower levels of eGFR,serum calcium,and hemoglobin.4.By the end of the study,a total of 34 patients had terminal events,including 17 patients in the morning peak hypertension group and 17 patients in the non-morning peak hypertension group.5.Kaplan-meier survival analysis was used to compare the incidence of endpoint events between the two groups.The results showed that the incidence of endpoint events in the morning peak hypertension group was significantly higher than that in the non-morning peak hypertension group(log rank=4.124,P=0.042 <0.05).6.COX regression model analysis: the correlative risk factors in the adjustment of traditional cardiovascular and uremia,increased blood pressure is the morning peak death for patients with chronic kidney disease(CKD),produce disease of heart head blood-vessel,into the independent risk factors for the development of end-stage renal disease,early morning peak,every increase 10 mmHg blood pressure in patients with chronic kidney disease(CKD),produce disease of heart head blood-vessel and to a 3.124 times increased risk of end-stage renal disease(HR 3.124,95% CI 1.096 9.130,p = 0.037).Conclusion:1.The incidence of morning peak blood pressure increase is higher in patients with CKD(32.7%),and morning peak blood pressure increase is an independent risk factor for endpoint events in patients with CKD.2.In terms of CKD blood pressure management,in addition to closely monitoring whether the patient's blood pressure is up tostandard,it is also necessary to pay attention to whether the patient's blood pressure increases in the morning peak,so as to delay the progress of CKD and reduce the incidence of cardiovascular and cerebrovascular diseases.