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FEATURES OF CIRCADIAN RHYTHM OF BLOOD PRESSURE IN PATIENTS WITH CHRONIC HEART FAILURE ASSOCIATED WITH CHRONIC KIDNEY DISEASE

O.V. Troshenkina, A.M. Shutov, V.A. Serov, A.A. Strakhov

Ulyanovsk State University

 

Despite the frequent combination of CHF and chronic kidney disease (CKD), main features of circadian rhythm in such patients are still poorly understood. The study included 180 patients with CHF. 86 patients had glomerular filtration rate (GFR) above 60 ml/min/1,73 m2, 57 patients – moderate decrease (GFR from 45 to 59 ml/min/1,73 m2), 37 patients – severe decrease (below 45 ml/min/1,73 m2). Correlation of SBP and DBP ND with GFR was revealed. Multivariate regression analysis confirmed an in­dependent relationship between reduced GFR below 45 ml/min/1,73 m2 and SBP and DBP ND. The study showed significant circadian rhythm disorders in patients with CHF associated with CKD.

Keywords: CHF, chronic kidney disease, circadian rhythm of blood pressure.

 

References

  1. Агеев Ф. Т., Арутюнов Г. П., Беленков Ю. Н. Хроническая сердечная недостаточность. М. : ГЭОТАР-Медиа, 2010. 336 с.

  2. Суточное мониторирование артериального давления: методические вопросы / А. Н. Рогоза [и др.] ; под ред. Г. Г. Арабидзе, О. Ю. Атькова. М., 1997. 37 с.

  3. Agarwal R. Systolic hypertension in hemodialysis patients // Semin. Dial. 2003. Vol. 16. Р. 208–213.

  4. Ambulatory blood pressure monitoring of patients with heart failure. A new prognosis marker / M. F. Canesin [et al.] // Arq. Bras. Cardiol. 2002. Vol. 78 (1). Р. 83–89.

  5. An investigation of the effect of advancing uraemia, renal replacement therapy and renal transplantation on blood pressure diurnal variability / C. K. Farmer [et al.] // Nephrol. Dial. Transplant. 1997. № 12. Р. 2301–2307.

  6. Association of diurnal blood pressure pattern with risk of hospitalization or death in men with heart failure/ J. Shin [et al.] // J. Card. Fail. 2007. Vol. 13 (8). Р. 656–662.

  7. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate / M. B. Davidson [et al.] // Arch. Intern. Med. 2006. Vol. 166. Р. 846–852.

  8. Associations between nondipping of noc-turnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives / S. Hoshide [et al.] // Am. J. Hypertens. 2003. Vol. 16 (6). Р. 434–438.

  9. Blood pressure is a major risk factor for renal death: an analysis of 560 352 participants from the Asia-Pacific region/ C. M. O'Seaghdha [et al.] // Hypertension. 2009. Vol. 54 (3). Р. 509–515.

  10. Cardiovascular risks of dipping status and chronic kidney disease in elderly Japanese hypertensive patients / J. Ishikawa [et al.] // J. Clin. Hypertens. 2008. Vol. 10 (10). Р. 787–794.

  11. Causes and mechanisms of nondipping hypertension / M. Kanbay [et al.] // Clin. Exp. Hypertens. 2008. Vol. 30 (7). Р. 585–597.

  12. Chronic Kidney Disease as an Independent Risk for Long-Term Adverse Outcomes in Patients Hospitalized With Heart Failure in Japan / S. Hama-guchi [et al.] // Circ J. 2009. Vol. 73 (8). Р. 1442–1447.

  13. Circadian blood pressure rhythm is disturbed by nephrectomy / N. Goto [et al.] // Hypertens. Res. 2005. Vol. 28 (4). Р. 301–306.

  14. Crowe E., Halpin D., Stevens P. Guideline Development Group. Early identification and management of chronic kidney disease: summary of NICE guidance // BMJ. 2008. Vol. 337. Р. 1530.

  15. Diurnal blood pressure pattern and risk of congestive heart failure / E. Ingelsson [et al.] // JAMA. 2006. Vol. 295 (24). Р. 2859–2866.

  16. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study / A. S. Go [ et al.] // Circulation. 2006. Vol. 113 (23). Р. 2713–2723.

  17. Hermida R. C., Ayala D. E. Circadian variation of blood pressure: the basis for the chronotherapy of hypertension // Portaluppi F.Adv. Drug Deliv. Rev. 2007. Vol. 59 (9–10). Р. 904–922.

  18. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification / A. S. Levey [et al.] // Ann. Intern. Med. 2003. Vol. 139 (2). Р. 137–147.

  19. Patients with renal dysfunction require a longer duration until blood pressure dips during the night / M. Fukuda [et al.] // Hypertension. 2008. Vol. 52 (6). Р. 1155–1160.

  20. Predictors of decreased renal function with heart failure during angiotensin-converting enzyme inhibitor therapy: results from studies of left ventricular dysfunction / E. L. Knight [et al.] // Am. Heart J. 1999. № 138. Р. 849–855.

  21. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients / A. de la Sierra [et al.] // Hypertension. 2009. Vol. 53 (3). Р. 466–472.

  22. Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease / K. Dimopoulos [et al.] // Circulation. 2008. Vol. 117 (18). Р. 2320–2328.

  23. Prisant L. M. Blunted nocturnal decline in blood pressure // J. Clin. Hypertens (Greenwich). 2004. Vol. 6 (10). Р. 594–597.

  24. Routledge F. S., McFetridge-Durdle J. A., Dean C. R. Canadian Hypertension Society. Night-time blood pressure patterns and target organ damage: a review // Can. J. Cardiol. 2007. Vol. 23 (2). Р. 132–138.

  25. Strict blood-pressure control and progression of renal failure in children / E. Wühl [et al.] ; ESCAPE Trial Group // N. Engl. J. Med. 2009. Vol. 361 (17). Р. 1639–1650

 

 

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УДК 616.12-008.46

ОСОБЕННОСТИ ЦИРКАДНОГО РИТМА АРТЕРИАЛЬНОГО ДАВЛЕНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ, АССОЦИИРОВАННОЙ С НАРУШЕНИЕМ ФУНКЦИИ ПОЧЕК

О.В. Трошенькина, А.М. Шутов, В.А. Серов, А.А Страхов

Ульяновский государственный университет

 

Несмотря на частое сочетание хронической сердечной недостаточности (ХСН) с хронической болезнью почек (ХБП), остаются недостаточно изученными особенности циркадного ритма АД у больных ХСН, ассоциированной с ХБП. Обследовано 180 больных ХСН. У 86 пациентов скорость клубочковой фильтрации (СКФ) была выше 60 мл/мин/1,73 м2, умеренное снижение СКФ от 45 до 59 мл/мин/1,73 м2 выявлено у 57 больных, у 37 больных отмечалось выраженное снижение СКФ – ниже 45 мл/мин/1,73 м2. Выявлена корреляция степени ночного снижения (СНС) САД и ДАД со СКФ. Проведение многофакторного регрессионного анализа подтвердило независимую связь между снижением СКФ менее 45 мл/мин/1,73 м2 и СНС САД и ДАД. Результаты исследования свидетельствуют о существенных нарушениях суточного ритма АД у больных ХСН, ассоциированной с ХБП.

Ключевые слова: хроническая сердечная недостаточность, хроническая болезнь почек, циркадный ритм АД.

 

Литература

  1. Агеев Ф. Т., Арутюнов Г. П., Беленков Ю. Н. Хроническая сердечная недостаточность. М. : ГЭОТАР-Медиа, 2010. 336 с.

  2. Суточное мониторирование артериального давления: методические вопросы / А. Н. Рогоза [и др.] ; под ред. Г. Г. Арабидзе, О. Ю. Атькова. М., 1997. 37 с.

  3. Agarwal R. Systolic hypertension in hemodialysis patients // Semin. Dial. 2003. Vol. 16. Р. 208–213.

  4. Ambulatory blood pressure monitoring of patients with heart failure. A new prognosis marker / M. F. Canesin [et al.] // Arq. Bras. Cardiol. 2002. Vol. 78 (1). Р. 83–89.

  5. An investigation of the effect of advancing uraemia, renal replacement therapy and renal transplantation on blood pressure diurnal variability / C. K. Farmer [et al.] // Nephrol. Dial. Transplant. 1997. № 12. Р. 2301–2307.

  6. Association of diurnal blood pressure pattern with risk of hospitalization or death in men with heart failure/ J. Shin [et al.] // J. Card. Fail. 2007. Vol. 13 (8). Р. 656–662.

  7. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate / M. B. Davidson [et al.] // Arch. Intern. Med. 2006. Vol. 166. Р. 846–852.

  8. Associations between nondipping of noc-turnal blood pressure decrease and cardiovascular target organ damage in strictly selected community-dwelling normotensives / S. Hoshide [et al.] // Am. J. Hypertens. 2003. Vol. 16 (6). Р. 434–438.

  9. Blood pressure is a major risk factor for renal death: an analysis of 560 352 participants from the Asia-Pacific region/ C. M. O'Seaghdha [et al.] // Hypertension. 2009. Vol. 54 (3). Р. 509–515.

  10. Cardiovascular risks of dipping status and chronic kidney disease in elderly Japanese hypertensive patients / J. Ishikawa [et al.] // J. Clin. Hypertens. 2008. Vol. 10 (10). Р. 787–794.

  11. Causes and mechanisms of nondipping hypertension / M. Kanbay [et al.] // Clin. Exp. Hypertens. 2008. Vol. 30 (7). Р. 585–597.

  12. Chronic Kidney Disease as an Independent Risk for Long-Term Adverse Outcomes in Patients Hospitalized With Heart Failure in Japan / S. Hama-guchi [et al.] // Circ J. 2009. Vol. 73 (8). Р. 1442–1447.

  13. Circadian blood pressure rhythm is disturbed by nephrectomy / N. Goto [et al.] // Hypertens. Res. 2005. Vol. 28 (4). Р. 301–306.

  14. Crowe E., Halpin D., Stevens P. Guideline Development Group. Early identification and management of chronic kidney disease: summary of NICE guidance // BMJ. 2008. Vol. 337. Р. 1530.

  15. Diurnal blood pressure pattern and risk of congestive heart failure / E. Ingelsson [et al.] // JAMA. 2006. Vol. 295 (24). Р. 2859–2866.

  16. Hemoglobin level, chronic kidney disease, and the risks of death and hospitalization in adults with chronic heart failure: the Anemia in Chronic Heart Failure: Outcomes and Resource Utilization (ANCHOR) Study / A. S. Go [ et al.] // Circulation. 2006. Vol. 113 (23). Р. 2713–2723.

  17. Hermida R. C., Ayala D. E. Circadian variation of blood pressure: the basis for the chronotherapy of hypertension // Portaluppi F.Adv. Drug Deliv. Rev. 2007. Vol. 59 (9–10). Р. 904–922.

  18. National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification / A. S. Levey [et al.] // Ann. Intern. Med. 2003. Vol. 139 (2). Р. 137–147.

  19. Patients with renal dysfunction require a longer duration until blood pressure dips during the night / M. Fukuda [et al.] // Hypertension. 2008. Vol. 52 (6). Р. 1155–1160.

  20. Predictors of decreased renal function with heart failure during angiotensin-converting enzyme inhibitor therapy: results from studies of left ventricular dysfunction / E. L. Knight [et al.] // Am. Heart J. 1999. № 138. Р. 849–855.

  21. Prevalence and factors associated with circadian blood pressure patterns in hypertensive patients / A. de la Sierra [et al.] // Hypertension. 2009. Vol. 53 (3). Р. 466–472.

  22. Prevalence, predictors, and prognostic value of renal dysfunction in adults with congenital heart disease / K. Dimopoulos [et al.] // Circulation. 2008. Vol. 117 (18). Р. 2320–2328.

  23. Prisant L. M. Blunted nocturnal decline in blood pressure // J. Clin. Hypertens (Greenwich). 2004. Vol. 6 (10). Р. 594–597.

  24. Routledge F. S., McFetridge-Durdle J. A., Dean C. R. Canadian Hypertension Society. Night-time blood pressure patterns and target organ damage: a review // Can. J. Cardiol. 2007. Vol. 23 (2). Р. 132–138.

  25. Strict blood-pressure control and progression of renal failure in children / E. Wühl [et al.] ; ESCAPE Trial Group // N. Engl. J. Med. 2009. Vol. 361 (17). Р. 1639–1650