Asociación entre el comportamiento non-dipper de la presión arterial y las fracciones del calcio sérico en pacientes hipertensos con disfunción renal crónica leve a moderada

摘要

Objectives: To Determine the association between total serum calcium (tCa) and ionic calcium (iCa), with MAPA measurements in hypertensive?patients with early renal failure. Methods: 231 hypertensive patients stages 1-3 of chronic kidney disease (CKD) were included. 24 Hr arterial pressure (AP) was determined by MAPA. Results: in non-dippers, the prevalence of Cr.Cl. 60 ml/mins/1.73 m2 was greater than in dippers (p0.02).?Covariance analysis showed that in stage 3 of K/DOQI, tCa was less in non-dippers than dippers (9.03 ± 0.66 vs. 9.41 ± 1 mg/dL, p0.02). In non-dippers, there were significant correlations between iCa and 24 hr- systolic AP (SAP)(r = 0.21, p 0.03), diurnal SAP (r=0.21, p0.03) and 24hr-PP (r = 0.23; p 0, 02). Non dippers showed a greater prevalence of the 24 Hr-PP in the highest tertile than dippers. Patients with Cr.Cl. ≥60 mL/min/1, 73 m2 have less propensity to present non-dipper patterns than patients with Clcr60 mL/min/1, 73 m2 (OR 2.44, IC 95% 1.39-4.27, p 0.002). Conclusions: Hypertensive patients in K/DOQI’s stage 3 present a greater alteration of AP’s circadian rhythm than those on stages 1-2. High prevalence of non-dippers in K/DOQI’s stage 3 suggests that even in moderate renal dysfunction, this circadian pattern is common. We can speculate that iCa has a role in the pathogenesis of disturbancves in the nocturnal physiological drop of AP. The Increase in arterial stiffness can be a important mechanism by which the nondipper pattern exerts its deleterious influence on cardiovascular and renal evolution of patients with CKD.