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To explore the rule of 24h ambulatory blood pressure in hypertensive patients with “hyper-filtration” stage renal damage.
A total of 513 untreated hypertensive patients with no complications were collected, and 376 patients were selected according to their data of estimated glomerular filtration rate (eGFR A total of 513 untreated hypertensive patients with no complications were collected, and 376 patients were selected according to their data of estimated glomerular filtration rate (eGFR≥90ml/min/1.73m2). Having been divided into high filtration group (102 cases, eGFR≥120ml/min/1.73m2) and normal filtration group(274 cases, 90 ml/min/1.73m2≤eGFR<120ml/min/1.73m2),these 376 patients were further divided into several subgroups based on their levels of urinary microalbumin-to-creatitine ratio(UACR) from low to high (high filtration group:A1-A4 subgroups;normal filtration group:B1-B4 subgroups). The variation of ambulatory blood pressure had been compared in each group.
In both high filtration group and the normal filtration grouop, the levels of urea nitrogen,triglyceride, total cholesterol and low density lipoprotein were not significantly increased with the increase of UACR. After adjusting for age and gender, in both high filtration group and normal filtration group, the mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP), nocturnal mean systolic blood pressure (nSBP), nocturnal mean diastolic pressure (nDBP) were higher with the increase of UACR within each group, especially nocturnal mean diastolic blood pressure (P<0.05). When UACR was positive (30mg/g≤UACR≤300mg/g), nSBP and nDBP were significantly higher, among which the high filtration rate group was more obvious (P <0.05). After adjusting for age and gender, whether in the high filtration group or normal filtration group, even if the UACR was within the normal range, the circadian blood pressure became abnormal; and with the increase in UACR, the proportion of patients with abnormal blood pressure rhythm significantly increased. And once UACR was ≥30mg/g, nSBP and nDBP decreased significantly within each group; more than 90% of patients lost normal blood pressure rhythm (P <0.05).
Nocturnal blood pressure was elevated and abnormal circadian rhythm occurred as hypertensive patients developed into “hyperfiltration” stage, whereas UACR was still within the normal range.