대한신장학회

논문분류	춘계학술대회 초록집
제목	Diabetic Nephropathy and Proteinuria are associated with Morning Hypertension and Nocturnal Non-dipping
저자	Se Won Oh1, Sang-Youb Han1, Ran-hui Cha2, Sejoong Kim3, Sun Ae Yoon4,Dong-Ryeol Ryu5, Ji Eun Oh6, Eun Young Lee7, Dong Ki Kim8, Yon Su Kim8
출판정보	2014; 2014(1):
키워드	당뇨, 아침 고혈압, 단백뇨
초록	Objectives: Morning hypertension (HTN) and nocturnal non-dipping are closely associated with target organ damage and risk of cardiovascular events. Alteration in the circadian variation of autonomic tone and blood pressure (BP) have been reported in diabetics. And proteinuria (PU) is a marker of reflecting the severity of diabetic nephropathy and endothelial dysfunction. We evaluate the risks of abnormal BP patterns according to the amount of PU in diabetics and non-diabetics. Methods: A total of 1,276 patients were prospectively recruited from 21 centers in Korea between October 2009 and May 2011. We included hypertensive patients who had an estimated glomerular filtration rate (eGFR) between 15 and 89 ml/min/1.73m2. Ambulatory 24 hour BP and urine protein creatinine ratio (UPCR) were assessed. Results: We stratified patients according to the presence of diabetes (DM) and PU (UPCR≥500 mg/g); DM-PU- (N=506), DM-PU+ (N=341), DM+PU- (N=189), and DM+PU+ (N=240). The adjusted systolic BP was the highest in DM+PU+ group during nighttime (22:30-5:00) and morning time (8:00-10:30). DM+PU+ group showed the highest prevalence of sustained HTN, non-dipping, and morning HTN (p<0.001). Although only morning HTN was significantly the highest in DM+PU+ group in patients with eGFR≥60 ml/min/1.73m2 (p=0.002), sustained HTN, non-dipping, and morning HTN were the highest in DM+PU+ group in patients with eGFR <60 ml/min/1.73m2 (p<0.001). The degree of PU significantly correlated with non-dipping and morning HTN both in diabetics and non-diabetics (p<0.02). In multivariate analysis, the significant risk factor for non-dipping was only DM+PU+ group, and DM+PU+ group showed the 1.58-fold risk increase for non-dipping compared with DM-PU- group (95% CI 1.10-2.27). Morning HTN was significantly associated with age, ECG score, and DMPU groups (p<0.02). The adjusted risks of morning HTN were 1.68 (95% CI 1.09-2.59) and 3.15 (95% CI 2.01-4.93) in DM-PU+ group and DM+PU+ group, compared with DM-PU- group, respectively. Conclusions: Diabetic nephropathy was significantly associated with non-dipping and morning HTN. And PU was significant risk factor for morning HTN in CKD stage 2- 4 patients irrespective of the presence of diabetics.
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