Abstract: Objective To investigate the intervention of morning blood pressure surge (MBPS) in maintenance hemodialysis (MHD) patients. Methods Ambulatory blood pressure monitoring was done in 260 MHD patients. According to the diagnostic criteria of MBPS, MHD patients with MBPS were selected as the research objects. They took the antihypertensives of levamlodipine besylate and telmisartan before sleep for 12 weeks to interfere with MBPS. Ambulatory blood pressure monitoring was conducted before and after the antihypertenive intervention. QT dispersion (QTd), left ventricular mass index (LVMI) and intima- media thickness (IMT) were also measured. Results ①24h SBP, postprandial 2 hours blood glucose, triglyceride and age of the patients were higher in MBPS group than in non-MBPS group (24h SBP: t=4.518, P=0.001; postprandial 2 hours blood glucose: t=15.361, P=0.000; triglyceride: t =5.338, P=0.000; age: t=2.472, P=0.013); urea clearance index (kt/V) and hemoglobin were lower in MBPS group than in non-MBPS group (Kt/V: t =4.750, P=0.001; Hb: t =3.477, P=0.001). ②In MBPS group after the treatment, 24h SBP, mean systolic blood pressure at night (nmSBP), and mean systolic blood pressure drop rate at night decreased significantly (24h SBP: t=4.518, P=0.001; nmSBP: t=5.964, P=0.001; mSBP drop rate at night: t=5.964, P=0.001); MBPS, mean systolic blood pressure at day (dmSBP), and 2h mSBP in the morning decreased more significantly as compared with those before treatment (MBPS: t=7.280, P=0.000; dmSBP: t=8.547, P=0.000; morning 2h
mSBP: t=9.002, P=0.000); diastolic blood pressure at night (nmDBP) drop rate (t=2.431, P=0.018) and nondipper hypertension rate (26% vs. 12%) decreased after the treatment. ③QTd, LVMI and IMT were abnormal in MHD patients with MBPS; QTd and IMT decreased after treatment (QTd: t=4.873, P=0.001; IMT: t=5.004, P=0.000). ④ Levamlodipine besylate and telmisartan have a higher trough to peak ratio (T/P) and smoothness index (SI). Conclusion MBPS exists in MHD patients; Levamlodipine besylate and telmisartan taken before sleep can effectively interfere with MBPS.

Key words: Maintenance hemodialysis, Morning Blood Pressure Surge, smoothness index, ambulatory blood pressure monitoring