24-satni profili krvnog tlaka u bolesnika s bolešću bubrega – iskustvo jednog centra

Vedad Herenda, Damir Rebić, Senad Hasanspahić, Aida Hamzić-Mehmedbašić, Azra Ribić-Mrkonja, Merima Odobašić

Uvod: Ovisno o rezultatima ambulantnog praćenja krvnog tlaka (ABPM), pacijenti imaju različite profile krvnog tlaka, a neke velike međunarodne studije pokušale su ispitati i usporediti profil kontinuiranog monitoringa krvnog tlaka (KMAT) pacijenata u različitim zemljama. U našoj studiji pokušali smo utvrditi profile arterijske hipertenzije naših pacijenata. Materijali i metode: Ovo je retrospektivna studija presjeka od listopada 2022. do travnja 2023. Ispitani su demografski, klinički i podatci o 24-satnom krvnom tlaku. Bolesnici su podijeljeni u nekoliko kategorija prema fenotipovima hipertenzije i dipping profilima. Analize su provedene koristeći mjere deskriptivne statistike. Rezultati: U studiju su bila uključena 94 bolesnika. Tijekom praćenja 12 pacijenata je umrlo. Hipertenzija bijele kute bila je najčešći fenotip hipertenzije u naših bolesnika (30,8%), a druga najveća skupina bila je trajna nekontrolirana hipertenzija (29,7%). Također, pronašli smo visoku prevalenciju non-dippers sistoličkog (43,6%) i obrnutog dipper dijastoličkog tlaka (42,5%). Rezultati pokazuju visoko značajne razlike između skupine koja je bila živa i skupine koja je umrla, s p < 0,001, što ukazuje da je profil krvnog tlaka povezan s ishodima preživljenja. Zaključci: Prevalencija visokorizičnog profila povišenoga krvnog tlaka u bubrežnih bolesnika je visoka. Zbog povišenoga noćnog krvnog tlaka u liječenju samo praćenje krvnog tlaka nije dovoljno. KMAT bi trebao postati zlatni standard za potvrdu odgovarajuće kontrole krvnog tlaka u bolesnika s bolešću bubrega.

BACKGROUND. Depending on results of ambulatory blood pressure monitoring (ABPM) patients have different hypertension profiles and some large international studies tried to examine and compare ABPM profile of patients in different countries. In our study we tried to establish hypertension profiles of our patients. MATERIALS AND METHODS. This is retrospective, cross-sectional study from October 2022 to April 2023. Demographic, clinical and 24-hour ambulatory blood-pressure data were examined. Patients were divided in several categories according to their hypertension phenotypes and dipping profiles. Analyses were conducted with descriptive statistics. RESULTS. 94 patients were included in study. During follow up 12 patients died. White-coat hypertension was the most common hypertension phenotype in our patients 30.8%, the second largest group was sustained uncontrolled hypertension (29.7%). Also, we have found high prevalence of non-dippers systolic (43.6%) and reverse dipper diastolic (42.5%). The results shows highly significant differences between group who was alive and group who died, with having p < 0.001, which indicates that the dipping status of blood pressure is associated with the survival outcomes. CONCLUSIONS. The prevalence of high-risk BP profile in renal
patients is high. Due to elevated nocturnal BP clinic BP monitoring alone is inadequate. ABPM should become golden standard to confirm adequate BP control in patients with kidney disease.