Blood pressure reduction in the morning yields beneficial effects on progression of chronic renal insufficiency with regression of left ventricular hypertrophy.

摘要

Self-monitoring values of blood pressure may better reflect the average long-term blood pressure value than sporadic measurements in the physician's office and be more useful for blood pressure control. In the present study, we compared the results of self-monitoring of blood pressure values, especially in the morning, with office blood pressure, and related these to progression of chronic renal insufficiency and left ventricular hypertrophy (LVH). Thirty-four patients were selected from 316 subjects with chronic renal insufficiency (average serum creatinine 1.72 +/- 0.15 mg/dl, mean age 52.6 +/- 3.5 yrs) in accordance with the following criteria (1) office blood pressure was less than 140/90 mmHg, (2) blood pressure was controlled with amlodipine (5-20 mg/day) combined with benazepril (2.5 mg/day), (3) morning blood pressure was greater than 150/90 mmHg at 6-9 AM and (4) LVH had been determined by echocardiography (posterior wall thickness; PWT > or = 12 mm). The patients were assigned to 2 groups at random and were given: (1) guanabenz (GB; 2-8 mg at I I PM, n = 17) or (2) placebo (n = 17). Two years later, the average blood pressure of both groups as measured in the office was not significantly different: however, BP in the morning was significantly reduced from 158 +/- 6 to 134 +/- 4 mmHg in GB treated group (P< 0.001). In 14 of 17 patients in GB treated group, LVH resolved and there was only mild progression of nephropathy (serum creatinine: 1.69 +/- 0.18 to 1.81 +/- 0.19 mg/dl). In 12 of 14 patients in placebo group, whose morning blood pressure remained at greater than 150/90 mmHg, LVH was retained and there was moderate progression of nephropathy (serum creatinine: 1.73 +/- 0.14 to 2.62 +/- 0.50mg/dl). From these results, it is suggested that antihypertensive treatment with combination therapy based on self-monitoring BP is cardio-renoprotective in patients with chronic renal insufficiency and LVH.