关键词: 肾疾病, 高血压, 血压监测,  , 便携式, 高血压

Abstract: Objective  To study the morphological characteristics of blood pressure in patients with chronic kidney disease (CKD) and the clinical effect of  antihypertensive drugs before bedtime on patients. Methods  The dynamic blood pressure data and clinical indicators of 182 CKD patients with hypertension who were hospitalized  from January 2018 to September 2019 were collected to describe the characteristics of patients  blood pressure  circadian rhythm and the distribution of special blood pressure types. The clinical  effect of taking antihypertensive drugs before bedtime on patients  were analyzed. Results  There were significant differences in age, 24hour systolic blood pressure, daytime systolic blood pressure and night systolic blood pressure among patients with different CKD stages. The pattern of blood pressure in CKD patients with hypertension was mainly  nondipper. Compared with the patients in  dippertype  blood pressure  group, the patients with nondipper or antidipper had higher age, higher hypersensitive Creactive protein (HSCRP) and lower hemoglobin. Multivariate regression analysis showed that age and HSCRP were independent risk factors for abnormal blood pressure rhythm. The blood pressure control rate of the patients in the  clinic  was  25.3%, the dynamic blood pressure control rate was 14.3%, the average control rate was 5.5%, and the uncontrolled blood pressure rate at  night  was 83.5%. 19.8% of the patients had masked hypertension, and whitecoat hypertension  was found in  8.8% of the patients. The 24hour urine protein and serum uric acid were significantly improved in patients who took antihypertensive drugs before going to bed for three months (P<0.05). Conclusion  The main pattern of blood pressure in patients with CKD complicated with hypertension is nondipper. Age and HSCRP are independent risk factors for abnormal blood pressure rhythm. Patients with lower hemoglobin are more likely to develop nondipper blood pressure. Taking antihypertensive drugs before bedtime may reduce urine protein and serum uric acid by restoring the circadian rhythm of blood pressure.

Key words: kidney diseases, hypertension；blood pressure monitoring, ambulatory, hypertension