Nighttime Losartan in Continous Ambulatory Peritoneal Dialysis (NVCAPD)
Nighttime Losartan in Continous Ambulatory Peritoneal Dialysis (NVCAPD)
Hypertension is one of the most important independent risk factors for the prognosis of
 continous ambulatory peritoneal dialysis patients. The incident rate is high and the control
 rate is low. Nocturnal hypertension has been paid more attention in recent years. Compared to
 daytime blood pressure, nocturnal blood pressure is an independent and efficient prognostic
 indicator of hypertensive deaths and cardiovascular events, but it is lack of evidence about
 its impact on prognosis in peritoneal dialysis patients and the effective treatment program.
 Our previous cohort study suggests that the incidence of nocturnal hypertension in patients
 with chronic kidney disease is up to 71.22%, with a significant increase as the decline of
 renal function, and more severe target organ damage in patients with nocturnal hypertension:
 the decrease of glomerular filtration rate, left ventricular hypertrophy, and the increase of
 all cause death and cardiovascular death. Our small sample size study show that night time
 antihypertensive drugs can better control blood pressure and delay the development of left
 ventricular hypertrophy. These preliminary results suggest that nocturnal hypertension is
 closely related to the prognosis of chronic renal disease. Taking antihypertensive drugs at
 night is one of the options for controlling nocturnal hypertension. However, it is not clear
 whether taking antihypertensive drugs at night can improve the prognosis of maintenance
 peritoneal dialysis patients with nocturnal hypertension. To this end, the investigators
 collect continous ambulatory peritoneal dialysis patients with nocturnal hypertension, and
 propose a time selective use of losartan to intervene in nocturnal hypertension. By comparing
 the difference in the effects of losartan on the prognosis of maintenance peritoneal dialysis
 patients during the day or night, to further clarify the role of nocturnal hypertension in
 the prognosis of maintenance peritoneal dialysis patients, whether controlling nocturnal
 hypertension can improve the prognosis of maintenance peritoneal dialysis patients. The
 completion of study will optimize the prevention and treatment of hypertension in maintenance
 peritoneal dialysis patients, and provide an evidence for precise prevention and treatment of
 nocturnal hypertension in maintenance peritoneal dialysis patients.
Inclusion Criteria:

 1. Age over 18 years old and <75 years.

 2. Diagnosed as chronic kidney disease 5th stage in accordance with the KDIGO guide 2012
 (egfr < 15 ml/ (min 1.73m2)).

 3. Accept 3-5 bags daily, continous ambulatory peritoneal dialysis for >3 months.

 4. Ambulatory blood pressure monitoring indicates nighttime systolic blood pressure (SBP)
 > 120mmHg and / or diastolic blood pressure (DBP) > 70mmHg.

 Exclusion Criteria:

 1. Night learning or work, irregular rest for a long time.

 2. Moderate and severe edema in difficult to correct

 3. Persistent atrial fibrillation.

 4. Severe anemia and severe dystrophy.

 5. Patients with postural hypotension or symptomatic hypotension.

 6. Severe side effects or contraindications of valsartan treatment.

 7. Treatment of corticosteroids or other hormones at present.

 8. Unable to cooperate or unable to tolerate ambulatory blood pressure monitoring.

 9. Ineffective ambulatory blood pressure data.

 10. The clinical data were incomplete during the treatment period; end-point events
 occurred within 6 months or follow-up time was less than 6 months.

 11. In the first 3 months before admission, there were obvious cardiovascular and
 cerebrovascular diseases such as coronary syndrome, myocardial infarction or stroke.

 12. There were complications such as vascular disease, infection and bleeding within 1
 months.