Research On The Relationship Between H-type Hypertension And Target Organ Damage In Patients With Diabetic Kidney Disease

Purpose:This study aims to clarify the prevalence of H-type hypertension in patients with diabetic kidney disease,analyze the relationship between H-type hypertension and DKD patients with eGFR decline,the occurrence of DR and the changes of c IMT.To explore the effect of H-type hypertension on the progression of diabetic kidney disease in patients with DKD,so as to provide a theoretical basis for clinical prevention and treatment.Method:Select 1,110 patients who were diagnosed with DKD at Lanzhou University Second Hospital from January 2016 to December 2018 for a cross-sectional study and calculate the prevalence of H-type hypertension in patients with diabetic kidney disease.According to the condition of H-type hypertension,the patients were divided into normal group,simple hypertension group,simple HHcy group,and H-type hypertension group.The baseline characteristics between the groups were compared,and the differences in eGFR decline,DR occurrence and c IMT changes between the groups were analyzed.Among them,264 patients with follow-up data will be followed up until June 2020.The first admission record of the follow-up patients was used as the baseline data of this retrospective cohort study.According to the baseline H-type hypertension of the follow-up patients,they were divided into normal group,simple hypertension group,simple HHcy group,and H-type hypertension group.At the end of the follow-up,the patients were divided into a progressive group and a non-progressive group according to whether there was progression of diabetic kidney disease.The Kaplan-Meier survival curve was used to compare the progress of diabetic kidney disease between groups,the difference in survival curve was tested by Log-Rank,and the Cox proportional hazard model was used to calculate the risk ratio of progression of diabetic kidney disease.Results:1.Among the 1,110 patients with diabetic kidney disease included in the study,the overall prevalence of H-type hypertension was 51.44%.The prevalence of H-type hypertension increased with the increase of CKD stages,and the prevalence of H-type hypertension in CKD1-5 stages was 36.53%,57.14%,69.87%,76.00%,88.52%,respectively.2.Results in the cross-sectional study:(1)Comparing the clinical data of the four groups:The levels of Cy S,Hcy,24h-UTP,Scr,UA,and PTH in the H-type hypertension group were higher than those of the other three groups(P<0.05),and age,BMI,diabetes course,SBP,and DBP were all higher than those in the normal group and the HHcy group alone(P<0.05),while Hb,ALB,and Ca are lower than the normal group and the pure HHcy group(P<0.05),and there was no significant difference in the course of hypertension,GLB,TG,LDL,and HDL among the four groups(P>0.05).(2)In patients with diabetic kidney disease,H-type hypertension is positively correlated with the course of hypertension,SBP,and Hcy(P<0.05),and negatively correlated with eGFR(P<0.05),and the risk of H-type hypertension in men is 1.838times than that of women(P<0.05).(3)In the study of the relationship between H-type hypertension and target organ damage in patients with diabetic kidney disease,it is concluded that H-type hypertension is related to the decrease of eGFR and the change of c IMT in patients with diabetic kidney disease.The eGFR level of patients with H-type hypertension is 9.259ml/min/1.73 m~2 lower than that of the normal group(P<0.05),the risk of c IMT thickening was 1.826 times that of the normal group(P=0.003<0.05),but there was no significant difference in the occurrence of DR between the two groups(P>0.05).3.Results in the retrospective cohort study:(1)At the end of the follow-up of 264 subjects,the average annual decrease in eGFR of the normal group,the simple hypertension group,the simple HHcy group,and the H-type hypertension group was 2.37±13.17ml/min/1.73m~2,2.10±15.90ml/min/1.73m~2,12.89±10.96ml/min/1.73m~2,13.19±13.23ml/min/1.73m~2,respectively.The rates of DKD progression in the four groups were 6.52%(3/46),6.12%(3/49),20.00%(7/35),and 26.87%(75/134).The rates of DKD progression in the four groups were 6.52%(3/46),6.12%(3/49),20.00%(7/35),and 26.87%(75/134).(2)The Kaplan-Meier curve of the risk of progression of DKD showed that the risk of progression in the H-type hypertension group was higher than that of the non-H-type hypertension group(P<0.001).In the COX proportional hazard model,after adjusting for confounding factors such as gender,age,BMI,baseline eGFR,hypertension,diabetes,and homocysteine,the risk of progression of diabetic nephropathy in the H-type hypertension group was still 1.971 times that of the non-H-type hypertension group(P=0.046<0.05).Conclusion:The prevalence of H-type hypertension in patients with DKD is high.H-type hypertension is closely related to the decrease of eGFR and the change of c IMT in patients with DKD.It also is an independent risk factor for the decrease in the average annual decline of eGFR in patients with DKD and the progression of DKD.Therefore,the management of H-type hypertension should be strengthened in clinical prevention and treatment.