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Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

机译:韩国慢性肾脏病患者的临床和动态血压差异

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摘要

Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1–G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1–2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1–2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin.
机译:血压(BP)控制被认为是预防慢性肾脏病(CKD)进展和相关的心血管并发症的最重要治疗方法。但是,临床BP不足以诊断高血压(HT)和监测总体BP控制,因为它与动态血压监测(ABPM)关联性不佳。我们从韩国3所医院招募了387例CKD高血压患者(G1-G4期,男性占58.4%,中位年龄61岁)。诊所BP和ABPM的HT分别分类为≥140/90和≥130/80 mmHg。临床血压控制率为60.2%。 CKD G3b和CKD G4的24小时收缩压中值显着高于CKD G1-2和CKD G3a。但是,CKD G1-2和CKD G3a之间或CKD G3b和CKD G4之间的24小时SBP中位数没有差异。在所有患者中,分别为5.7%,38.0%。分别为42.3%和14.0%的是极限北斗星,北斗星,非北斗星和反向北斗星。非/反向北斗星独立地与较高的Ca×P产物,较高的完整甲状旁腺激素(iPTH)和较低的白蛋白相关。正常BP为33.3%,持续性,掩蔽性和白涂层HT分别为29.7%,26.9%和10.1%。白大衣HT与年龄≥61岁独立相关,而蒙面HT与CKD G3b / G4独立相关。总之,ABPM揭示了韩国CKD患者中非/反向使用北斗星和持续/掩蔽性HT的高患病率。临床医生应尝试获取CKD患者的ABPM,尤其是年龄较大或患有CKD的患者以及Ca×P产物,iPTH和白蛋白异常的患者。

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