Ambulatory blood pressure in type 2 diabetic patients with different degrees of chronic kidney disease

Abstract

Objective To investigate the characteristics of the 24 h ambulatory blood pressure in type 2 diabetic patients with chronic kidney disease(CKD). Methods A total of 510 type 2 diabetic patients hospitalized from September 2009 to December 2013 were enrolled in this study. The patients were divided into six groups according to K/DOQI staging of CKD: non-CKD(94 cases), stage 1 CKD(134 cases), stage 2 CKD(122 cases), stage 3 CKD(80 cases), stage 4 CKD(36 cases) and stage 5 CKD(44 cases). The incidence of hypertension in those groups were calculated. The data were compared with one-way analysis of variance among groups. Multiple stepwise regression analysis was applied to evaluate the effect of every indicators on estimated glomerular filtration rate. Results The incidence of hypertension increased significantly in type 2 diabetic patients with CKD, with a incidence rate of 95.4% in stage 5 patients(χ2=54.533, P 0.05). The predictors of atherosclerosis, pulse pressure and ambulatory arterial stiffness index, increased significantly along with the progression of CKD(F=32.829, 10.134, P<0.05). The decrease of nighttime systolic and diastolic blood pressure declined along with CKD progression (F=17.827, 10.519,P<0.05). Multiple stepwise regression analysis indicated that estimated glomerular filtration rate was negatively correlated with systolic blood pressure and pulse pressure(β=-0.201,-0.237, both P<0.01),and positively correlated with body mass index, percentage of night reduction rate of diastolic pressure and smoothness index of systolic blood pressure (β=0.134,0.151,0.145, all P<0.05). Conclusion The incidence of hypertension increased significantly in type 2 diabetic patients with CKD, with increasing of systolic blood pressure and pulse pressure and obvious abnormal circadian rhythm. So monitoring on blood pressure rhythm of these patients should be strengthened. Key words: Diabetes mellitus, tpye 2; Chronic kidney disease; Hypertension; Prevalence; Circadian rhythm