FEATURES OF DAILY BLOOD PRESSURE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE

Abstract

Objective: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Design and method: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to glomerular filtration rate (eGFR), according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicom-combi device (Russia). Results: Among the examined patients, preserved renal function of CKD C1 was observed in 20.8% (n = 25); CKD C2 – in 50.8% (n = 61); CKD C3A – in 19.2% (n = 23); CKD C3B – in 9.2% (n = 11) p<0.001. CKD C4 and terminal stages were not detected. It was revealed that according to increasing of degree of CKD, values of the average daily SBP (p = 0.013) average daytime SBP (p = 0.04), mean night SBP (p = 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values, p = 0.001. A normal daily profile of SBP/DBP had 28%/32% of patients of the 1st group vs 24.61%/37.70% of patients of the 2nd group vs 37.78%/21.73% of patients of the 3rd group vs 0% /0% of patients of the 4th group, SBP ⇙2 = 40.62 p<0.01; DBP ⇙2 = 47.21, p<0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKD C3b: night reduction speed (NRS) SBP 40% in group 1 vs 49.1% in group 2 vs 52.17% in group 3 vs 54.54% in group 4 group ⇙2 = 9.35, p = 0.02. In the group of patients with CKD C3b, individuals with a daily profile of SBP/DBP night-pickers significantly prevailed: 32%/20% vs 14.75%/13.11% vs 13.04%/13.04% vs 45.45%/ 54.54% (in groups 1, 2, 3 and 4, respectively) in SBP ⇙2 = 32.47 p<0.001, in DBP ⇙2 = 64.25 p<0.001. There was a significant increase in patients with a daily profile of over-dipper according to DBP in patients with CKD C3b:0% vs 4.91% vs 13.04% vs 27.27% ⇙2 = 41.47, p<0.001. Conclusions: AH patients with CKD have more pronounced disturbances in the daily blood pressure profile, which contribute to an increased risk of developing complications of arterial hypertension.