|摘要||目的 研究老年慢性肾脏病(CKD)合并高血压患者的血压特点.方法 回顾性分析2010年1月至2012年12月于北京大学第一医院肾内科住院并接受了动态血压监测(ABPM)的CKD患者的临床资料,包括诊室血压(CBP)、年龄、性别、基础合并症(糖尿病、心血管疾病)、高血压治疗方案(联合用药、睡前用药)、估测的肾小球滤过率(eGFR)及尿蛋白定量,以年龄≥60岁为老年标准,分析老年CKD合并高血压患者血压特点及相关影响因素.结果 共337例患者纳入分析,其中94例(27.9％)为老性患者.与非老年患者相比,老年患者白大衣现象更常见[24.5％ (23/94)比12.3％(30/243),P=0.008];在收缩压水平相当的情况下,全天平均舒张压、白天及夜间舒张压更低(均P＜0.001);收缩压(P =0.023)及舒张压(P=0.002)的血压变异率更高,血压晨峰现象更多见[11.7％(11/94)比3.7％(9/243),P=0.009];反杓型血压节律比例更高[41.5％(39/94)比25.1％(61/243),P=0.004].增龄是白大衣现象(OR=1.024,95％CI:1.004 ～ 1.044,P=0.017)和反杓型血压节律(OR=1.016,95％ CI:1.001～1.032,P=0.037)的独立影响因素.结论 老年CKD合并高血压患者具有与非老年患者不同的血压特点.应重视ABPM的应用,优化老年CKD合并高血压患者的血压管理.
Objective To identify the characteristics of blood pressure (BP) in the elderly hypertensive patients with chronic kidney disease (CKD).Methods We retrospectively recruited 337 CKD patients who had been admitted into our renal unit during January 2010 to December 2012 and undergone clinical blood pressure (CBP) and ambulatory blood pressure (ABP) measurement with detailed clinical data.Those with age ≥60 years old (n =94) were designated as elderly patients and their BP data were compared with those of young-and middle-aged patients (＜ 60 years old,n =243).Logistic regression was adopted to analyze the independent risk factor for white-coat hypertension and reverse-dipper rhythm.Results Compared to those ＜ 60 y,the elder CKD patients had the following characteristics:(1) Higher prevalence of white-coat hypertension (24.5％ vs 12.3％,P =0.008).(2) Significantly lower diastolic blood pressure of average 24 h,daytime and nighttime by ambulatory monitoring of blood pressure (ABPM) (all P ＜ 0.001).(3) Higher BP variability with significant difference (all P ＜ 0.05) and more patients with morning surge (11.7％ vs 3.7％,P =0.009).(4) Higher prevalence of reverse-dipper circadian BP rhythm (41.5 ％ vs 25.1％,P =0.004).(5) Age was an independent predictor for white-coat hypertension (OR =1.024,95％ CI:1.004-1.044) and reverse-dipper circadian BP rhythm (OR =1.016,95％ CI:1.001-1.032).Conclusions The BP profile of elderly hypertensive CKD patients is different from that of young-and middle-aged patients.ABPM should be more commonly performed to improve BP treatment of elderly CKD patients.|