PS-C09-6: FEATURES OF DAILY BLOOD PRESSURE PROFILE IN PATIENTS WITH ARTERIAL HYPERTENSION WITH CHRONIC KIDNEY DISEASE
Abstract
Purpose of the study: To study the daily profile of blood pressure in patients with arterial hypertension (AH) with chronic kidney disease (CKD). Materials and methods of the study: The study included 120 patients with AH I-III degree, who received inpatient treatment. CKD stages were determined according to the modern KDIGO 2013 classification. Daily blood pressure profile (DAP) was assessed using the Medicomcombi device (Russia). Results of the study: Among the examined patients, preserved renal function of CKDC1 (eGFR> 90 ml/min/1.73 m2) was observed in 20.8% (n = 25); CKDC2 (eGFR 60–89 ml/min/1.73m2) in 50.8% (n = 61); CKDC3A (eGFR 45–59 ml/min/1.73m2) in 19.2% (n = 23); CKDC3B (eGFR 30–44 ml/min/1.73m2) in 9.2% (n = 11) p < 0.001. CKDC4 and terminal stages were not detected. When analyzing ambulatory blood pressure monitoring (ABPM), it was revealed that according to increasing of degree of CKD, values of the average daily SBP (122.52 ± 9.25 vs 122.13 ± 12.30 vs 121.74 ± 9.43 vs 134.36 ± 15.32 mm Hg, p < 0.013) average daytime SBP (123.56 ± 8.99 vs. 124.00 ± 611.89 vs 123.74 ± 9.73 vs 134.27 ± 15.12 mmHg, p < 0.04), mean night SBP (119.80 ± 13.39 vs 116.75 ± 14.59 vs 116.09 ± 12, 04 vs 135.09 ± 16.66 mm Hg, p < 0.001) significantly rises. The load index of elevated daytime and nighttime SBP was high in AH patients with lower eGFR values. Index of SBP daytime: 13.00 ± 14.05 vs 15.43 ± 21.22 vs 10.70 ± 15.04 vs 35.10 ± 34.14% respectively, p < 0.01. Index of SAP nighttime were 33.75 ± 29.35 vs 26.04 ± 31.07 vs 26.58 ± 27.87% vs 66.10 ± 36.05% respectively,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 p < 0.01; DBP p < 0.001. The number of non-dippers in SBP was somewhat higher in the group of patients with CKDC3b: 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, p < 0.02. In the group of patients with CKDC3b, 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 p < 0.001, in DBP p < 0.001. There was a significant increase in patients with a daily profile of “over-dipper” according to DBP in patients with CKDC3b:0% vs 4.91% vs 13.04% vs 27.27% p < 0.001. Conclusion: 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.