Correlation between morning blood pressure surge, heart rate variability, and vascular endothelial damage in chronic kidney disease patients

doi:10.3877/cma.j.issn.1674-0785.2021.12.019

Abstract

Abstract:

Objective

To investigate the relationship between morning blood pressure surge, heart rate variability, and vascular endothelial damage in chronic kidney disease (CKD) patients, in order to clarify the mechanism of blood pressure change in CKD.

Methods

In this prospective observational study, 70 patients with CKD treated at Nephrology Department of Liyang Branch of Jiangsu Provincial People's Hospital were selected. According to estimated glomerular filtration rate (eGFR), the patients were divided into a mildly decreased renal function group (n=35), and a moderately to severely decreased renal function group (n=35). Meanwhile, 30 healthy patients without CKD were selected as a normal control group. Morning peak blood pressure, heart rate variability [time domain indexes: standard deviation of normal-to-normal intervals (SDNN), standard deviation of averaged normal-to-normal intervals (SDANN) , root of the mean square of successive differences (rMSSD), percentage of adjacent normal-to-normal intervals differing by＞50 ms (pNN50); frequency domain indexes: low frequency (LF), high frequency (HF), and LF/ HF], and vascular endothelial damage [serum endothelin-1 (ET-1) and serum nitric oxide (NO)] were detected and compared among the three groups using one-way ANOVA. The morning peak blood pressure was defined as the 1 h mean blood pressure difference value ≥35 mmHg (1 mmHg=0.133 kPa) between the mean blood pressure 2 h after getting up and the minimum blood pressure at night. Patients of the three groups were divided into a morning peak blood pressure subgroup and a non-morning peak blood pressure subgroup, respectively, and the heart rate variability and vascular endothelial damage of these two subgroups were compared. The correlation of morning blood pressure peak with heart rate variation and vascular endothelial damage was analyzed using Pearson correlation analysis.

Results

Compared with the normal control group, the proportion of patients with morning blood pressure surge, LF, and ET-1 significantly increased, but rMSSD, HF, LF/HF, and NO significantly decreased in the mildly decreased renal function group (P＜0.05). Compared with the normal control group and mildly decreased renal function group, the proportion of patients with morning blood pressure surge and ET-1 significantly increased, but pNN50, LF, LF/HF, and NO significantly decreased in the moderately to severely decreased renal function group (P＜0.05). In the normal control group, compared with the non-morning peak blood pressure subgroup, SDNN, rMSSD, pNN50, HF, LF/HF, and NO of morning peak blood pressure group significantly deceased, but LF and ET-1 significantly increased in the non-morning peak blood pressure subgroup (P＜0.05). In the mildly decreased renal function group, compared with the non-morning peak blood pressure subgroup, pNN50, LF/HF, and NO significantly deceased, but ET-1 significantly increased in the non-morning peak blood pressure subgroup (P＜0.05). In the moderately to severely decreased renal function group, compared with the non-morning peak blood pressure subgroup, SDANN, LF, LF/HF, and NO significantly deceased, but ET-1 significantly increased in the non-morning peak blood pressure subgroup (P＜0.05). Among CKD patients, the morning blood pressure surge were negatively correlated with SDNN, SDANN, rMSSD, pNN50, LF, HF, LF/ HF, and NO (P＜0.05), and positively correlated with ET-1 (P＜0.05).

Conclusion

Morning blood pressure surge, heart rate variability, and vascular endothelial damage are common in patients with CKD, and there are correlations between morning blood pressure surge and heart rate variability and vascular endothelial damage in CKD patients.

Key words: Chronic kidney disease, Morning blood pressure surge, Heart rate variability, Vascular endothelial damage

Liyu Shen, Na Lv, Ying Shi, Wei Wei. Correlation between morning blood pressure surge, heart rate variability, and vascular endothelial damage in chronic kidney disease patients[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(12): 1016-1023.

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Figures/Tables 7

组别	例数	年龄（岁， $x ¯$ ±s）	男性［例（%）］	体质量指数（kg/m²， $x ¯$ ±s）	吸烟［例（%）］	饮酒［例（%）］
健康对照组	30	64.45±6.11	16（48.5）	26.48±1.91	18（54.54）	14（42.42）
肾功能轻度下降组	35	63.64±8.40	16（48.5）	26.16±1.71	16（48.48）	17（51.52）
肾功能中重度下降组	35	65.45±8.12	17（51.5）	26.07±2.69	15（45.45）	19（57.57）
统计值		F=0.472	χ²=0.039	F=1.511	χ²=0.276	χ²=0.118
P值		0.625	0.962	0.226	0.760	0.889

组别	例数	年龄（岁， $x ¯$ ±s）	男性［例（%）］	体质量指数（kg/m²， $x ¯$ ±s）	吸烟［例（%）］	饮酒［例（%）］
健康对照组	30	64.45±6.11	16（48.5）	26.48±1.91	18（54.54）	14（42.42）
肾功能轻度下降组	35	63.64±8.40	16（48.5）	26.16±1.71	16（48.48）	17（51.52）
肾功能中重度下降组	35	65.45±8.12	17（51.5）	26.07±2.69	15（45.45）	19（57.57）
统计值		F=0.472	χ²=0.039	F=1.511	χ²=0.276	χ²=0.118
P值		0.625	0.962	0.226	0.760	0.889

项目	健康对照组（30例）	肾功能轻度下降（35例）	肾功能中重度下降组（35例）	统计值	P值
血压晨峰［例（%）］	2（6.67）	16（45.71）^a	33（94.30）^ab	χ²=80.947	＜0.001
SDNN（ms， $x ¯$ ±s）	115.29±43.72	113.25±37.00	101.03±11.50	F=1.726	0.204
SDANN（ms， $x ¯$ ±s）	89.57±16.81	90.46±15.98	90.35±16.87	F=0.028	0.972
rMSSD（ms， $x ¯$ ±s）	40.56±16.66	34.15±11.34^a	29.98±7.28^a	F=6.128	0.003
pNN50（%， $x ¯$ ±s）	9.16±6.14	8.86±5.65	3.10±1.01^ab	F=16.350	＜0.001
LF（ms， $x ¯$ ±s）	1034.57±354.70	2515.81±524.39^a	333.11±115.59^ab	F=296.149	＜0.001
HF（ms， $x ¯$ ±s）	751.72±207.64	427.98±216.53^a	359.66±173.85^a	F=36.119	＜0.001
LF/HF（ $x ¯$ ±s）	2.09±0.53	1.78±0.62^a	1.44±0.37^ab	F=12.848	＜0.001
血清ET-1（ng/L， $x ¯$ ±s）	23.41±7.89	65.74±6.80^a	89.32±6.78^ab	F=714.380	＜0.001
血清NO（mmol/L， $x ¯$ ±s）	125.49±4.55	81.61±9.43^a	47.93±4.63^ab	F=1140.848	＜0.001

项目	健康对照组（30例）	肾功能轻度下降（35例）	肾功能中重度下降组（35例）	统计值	P值
血压晨峰［例（%）］	2（6.67）	16（45.71）^a	33（94.30）^ab	χ²=80.947	＜0.001
SDNN（ms， $x ¯$ ±s）	115.29±43.72	113.25±37.00	101.03±11.50	F=1.726	0.204
SDANN（ms， $x ¯$ ±s）	89.57±16.81	90.46±15.98	90.35±16.87	F=0.028	0.972
rMSSD（ms， $x ¯$ ±s）	40.56±16.66	34.15±11.34^a	29.98±7.28^a	F=6.128	0.003
pNN50（%， $x ¯$ ±s）	9.16±6.14	8.86±5.65	3.10±1.01^ab	F=16.350	＜0.001
LF（ms， $x ¯$ ±s）	1034.57±354.70	2515.81±524.39^a	333.11±115.59^ab	F=296.149	＜0.001
HF（ms， $x ¯$ ±s）	751.72±207.64	427.98±216.53^a	359.66±173.85^a	F=36.119	＜0.001
LF/HF（ $x ¯$ ±s）	2.09±0.53	1.78±0.62^a	1.44±0.37^ab	F=12.848	＜0.001
血清ET-1（ng/L， $x ¯$ ±s）	23.41±7.89	65.74±6.80^a	89.32±6.78^ab	F=714.380	＜0.001
血清NO（mmol/L， $x ¯$ ±s）	125.49±4.55	81.61±9.43^a	47.93±4.63^ab	F=1140.848	＜0.001

项目	非血压晨峰组（28例）	血压晨峰组（2例）	t值	P值
SDNN（ms）	152.43±29.87	116.16±0.01	6.313	0.018
SDANN（ms）	111.23±5.06	102.11±0.01	3.530	0.071
rMSSD（ms）	52.08±7.68	41.06±0.25	5.808	0.023
pNN50（%）	15.12±2.32	9.74±0.12	4.823	0.037
LF（ms）	2242.53±392.33	3014.73±72.76	5.211	0.030
HF（ms）	841.07±154.4	634.58±1.57	13.010	0.001
LF/HF	2.52±0.31	2.08±0.01	14.547	0.001
血清ET-1（ng/L）	21.23±3.23	27.05±0.27	13.508	0.001
血清NO（mmol/L）	126.95±3.62	120.28±1.14	5.393	0.028

项目	非血压晨峰组（19例）	血压晨峰组（16例）	t值	P值
SDNN（ms）	109.75±3.38	99.88±3.12	0.086	0.771
SDANN（ms）	94.49±2.96	87.18±2.10	0.052	0.820
rMSSD（ms）	37.29±1.93	31.19±1.54	1.037	0.316
pNN50（%）	7.19±1.34	4.09±0.54	19.064	＜0.001
LF（ms）	1445.13±238.52	812.64±208.05	0.497	0.486
HF（ms）	580.22±30.77	479.79±44.56	3.632	0.065
LF/HF	1.86±0.09	1.62±0.06	4.091	0.049
血清ET-1（ng/L）	55.99±12.68	67.04±2.06	10.723	0.002
血清NO（mmol/L）	96.23±12.28	75.04±5.35	5.920	0.021

项目	非血压晨峰组（2例）	血压晨峰组（33例）	t值	P值
SDNN（ms）	94.85±0.01	80.46±17.69	1.943	0.173
SDANN（ms）	83.69±0.01	71.45±5.91	6.593	0.015
rMSSD（ms）	27.53±0.03	21.32±3.41	3.355	0.076
pNN50（%）	2.98±0.01	1.86±0.82	3.258	0.080
LF（ms）	508.34±3.11	328.59±113.16	10.304	0.003
HF（ms）	370.18±10.03	223.62±85.17	3.792	0.060
LF/HF	1.52±0.02	1.17±0.24	7.524	0.010
血清ET-1（ng/L）	72.31±0.97	90.34±5.02	5.359	0.027
血清NO（mmol/L）	68.65±1.21	47.93±4.64	5.197	0.029

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