老年高血压患者动态血压与肾功能损害

Relationship between the ambulatory blood pressure and renal function in elderly patients with hypertension

目的:探讨老年高血压患者动态血压与慢性肾功能损害的关系。方法:对已服降压药物控制血压的老年高血压患者测定24h动态血压,以血清肌酐(SCr)代入简化MDRD公式估算肾小球滤过率(GFR),以GFR<60mL·min-1·1.73m-2设为肾功能不全组(男性40例,女性5例),与GFR≥60mL·min-1·1.73m-2、年龄、性别匹配的45例比较。结果:1.2组患者年龄相近,(77.0±6.1)岁vs(76.9±5.5)岁,P>0.05;SCr、GFR差异有统计学意义。2.90例中非勺型血压71例占78.9%,2组比较差异无统计学意义,38/45vs33/45,χ2=1.668,P>0.05。3.肾功能不全组平均舒张压(DBP)、日间舒张压(dDBP)、最高舒张压(DBPmax)、舒张压波动幅度(△DBP=最高舒张压-最低舒张压)明显低于对照组,平均脉压(PP)及夜间脉压(nPP)明显高于对照组,均P<0.05。Logistic多元回归分析显示,△DBP降低与nPP增加为肾功能不全的独立危险因素,OR值分别为0.941(95%CI0.894～0.991)和1.043(95%CI1.006～1.081)。4.GFR与DBPmax、△DBP正相关,与PP、nPP、nSBP负相关,在控制年龄因素后相关性依然具有统计学意义,均P<0.05;△DBP与DBPmax显著正相关,r=0.820,P<0.01,而与最低舒张压(DBPmin)无相关性。结论:合并有肾功能不全的老年高血压患者较对照人群明显有增加的PP和降低的DBP水平。其nPP的增加和△DBP的降低与肾功能损害有关。降压治疗的老年患者,PP(尤其nPP)的增加和△DBP的降低可能对GFR下降存在不利影响。

Objective：To investigate the relationship between the ambulatory blood pressure and renal function in elderly patients with hypertension.Methods：A 1：1 matched cases-control study was performed in 90 elderly patients with treated hypertension.45 cases with glomerular filtration rate（GFR） 60 mL/min per 1.73 m2 estimated with the simplified modification of diet in renal disease study（MDRD） equation were definited to renal disfunction and the others with GFR 60 mL/min per 1.73 m2,year and gender matched-pairs were as controls.Results：There were 71 cases with non-dipping blood pressure in all of patients and was no significant difference in cases distribution between two groups.Comparing with the patients in control group,The patients with renal dysfunction had significantly increased pulse pressure（PP）,nocturnal PP（nPP） and declined levels of diastolic blood pressure（DBP）,maximal DBP（DBPmax） and DBP fluctuated amplitude（△DBP）.In multivariate logistic regression analysis,the decline of △DBP and increase of nPP were independent risk factors for renal disfunction,（odds ratio[OR],0.941,1.043,95% confidence interval[CI],0.894 to 0.991,1.006 to 1.081,respectively）.The GFR was positive correlated with DBPmax,△DBP and nagetive correlated with PP,nPP,nocturnal systolic blood pressure（nSBP）,P〈0.05.The △DBP was positive correlated with DBPmax（r = 0.820,P〈0.01）and no relative to DBPmin.Conclusion：The elderly patients of treated hypertension with renal dysfunction had more increased PP and declined DBP than the cases with normal renal function.The nPP was an independent risk factor for renal dysfunction.It is suggested that the increase of nPP and decline of DBP may have a detrimental influence on the decline in GFR in elderly patients with treated hypertension.