Nephrology Dialysis Transplantation, Vol 14, Issue 1 86-90, Copyright © 1999 by Oxford University Press
B Csiky, T Kovacs, L Wagner, T Vass and J Nagy
Background: Hypertension is a recognized marker of
poor prognosis in IgA nephropathy. Methods: The
present study investigated the prevalence of white-coat hypertension, the
diurnal rhythm of blood pressure (BP), the effectiveness of
antihypertensive drug therapy, and the effect of the above on the
progression of the kidney disease in IgA nephropathy. One hundred
twenty-six IgA nephropathy patients were selected consecutively for 24-h
ambulatory blood pressure monitoring (ABPM). Fifty-five patients were
normotensive and 71 were treated hypertensives. Their antihypertensive
drugs were angiotensin-converting enzyme inhibitors (ACEI) alone or in
combination with calcium-channel blockers (CCB).
Results: The mean night-time BP of normotensives
(108±9/67±6 mmHg) was significantly lower than their
day-time BP (125±8/82±7 mmHg, P<0.05). There
was no significant difference between the mean day-time and night-time BP
in hypertensive patients (125±9/82±7 mmHg
vs 128±10/85±9 mmHg). The
circadian variation of BP was preserved ('dippers') in 82% of the
normotensive and 7% of the hypertensive patients (P<0.001). There
were 10 'white-coat hypertensives' among the patients classified as
normotensives with ABPM (mean office blood pressure
149±7/96±8 mmHg, 24-h blood pressure
127±6/83±5 mmHg, P<0.05) and 14 among treated
hypertensives (mean office BP 152±8/98±6 mmHg, 24-h
BP 130±4/85±8 mmHg, P<0.05). There was no
difference in mean day-time BP among normotensive and treated hypertensive
patients (125±8/81±5 mmHg
vs128±10/85±9 mmHg).
Hypertensives had significantly higher night-time BP
(125±9/85±9 mmHg) than normotensives
(108±9/67±6 mmHg, P<0.001). There was no
difference in serum creatinine levels among the different groups at the
time of ABPM. However, thirty-six±4.1 months after the ABPM,
hypertensive patients (n=52) had higher serum creatinine levels
(124±32 &mgr;mol/l) than at the time of the ABPM
(101±28 &mgr;/l). The serum creatinine of normotensive
patients (n=43) did not change during the following period (n=43) did not
change during the follow-up period. 'Non-dipper' normotensives (n=10) had
significantly higher serum creatinine levels at the end of the follow-up
period than at its beginning (106±17 &mgr;mol/l
vs 89±18 &mgr;mol/l, P<0.05).
There was no increase in serum creatinine of 'dipper' normotensives. The
mean serum creatinine of 'white-coat hypertensives' was significantly
higher at the end of the study period than at its beginning.
Conclusions: There is no diurnal blood pressure
variation in most of the hypertensive IgA nephropathy patients. ACEI and
CCB treatment have better effect on day-time than night-time hypertension.
The lack of the circadian rhythm and 'white-coat hypertension' seems to
accelerate the progression of IgA nephropathy. Key
words: ambulatory blood pressure monitoring; diurnal blood
pressure rhythm; IgA nephropathy; progression of renal disease; white-coat
hypertension
ORIGINAL ARTICLES
Ambulatory blood pressure monitoring and progression in patients with IgA nephropathy
Nephrological Centre and Second Department of Medicine, University Medical School of Pecs and Fresenius Dialysis Centre, Pecs, Hungary; Corresponding author at: Nephrological Centre, Second Department of Medicine, University School of Pecs, Pacsirta u. 1, H-7624 Pecs, Hungary
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