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Chinese Journal of Clinicians(Electronic Edition) ›› 2021, Vol. 15 ›› Issue (12): 1016-1023. doi: 10.3877/cma.j.issn.1674-0785.2021.12.019

• Clinical Research • Previous Articles     Next Articles

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

Liyu Shen1,(), Na Lv1, Ying Shi1, Wei Wei1   

  1. 1. Department of Nephrology, Liyang Branch of Jiangsu Provincial People's Hospital Liyang People's Hospital, Liyang 213300, China
  • Received:2021-06-03 Online:2021-12-15 Published:2022-04-16
  • Contact: Liyu Shen

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

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