Loss of Nocturnal Decline of Blood Pressure in Hypertension due to Chronic Renal Failure

Portaluppi, Francesco; Montanari, L.; Massari, M; Chiara, V Di; Capanna, Michele

doi:10.1093/ajh/4.1.20

Cited by 161 publications

(71 citation statements)

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“…14 In other studies, nondippers had higher levels of proteinuria 15 and a more rapid decline in renal function than dippers. 16 The nondipping pattern of BP has been reported to be more common in African American subjects without kidney disease.…”

Section: Discussionmentioning

confidence: 86%

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

et al. 2009

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Abstract-Ambulatory blood pressure (ABP) monitoring provides unique information about day-night patterns of blood pressure (BP). The objectives of this article were to describe ABP patterns in African Americans with hypertensive kidney disease, to examine the joint distribution of clinic BP and ABP, and to determine associations of hypertensive target organ damage with clinic BP and ABP. This study is a cross-sectional analysis of baseline data from the African American Study of Kidney Disease Cohort Study. Masked hypertension was defined by elevated daytime (Ն135/ 85 mm Hg) or elevated nighttime (Ն120/70 mm Hg) ABP in those with controlled clinic BP (Ͻ140/90 mm Hg); nondipping was defined by a Յ10% decrease in mean nighttime systolic BP; reverse dipping was defined by a higher nighttime than daytime systolic BP. Of the 617 participants (mean age: 60.2 years; 62% male; mean estimated glomerular filtration rate: 43.8 mL/min per 1.73 m 2 ) with both clinic BP and ABP, 498 participants (80%) had a nondipping or reverse dipping profile. Of the 377 participants with controlled clinic BP (61%), 70% had masked hypertension. Compared with those with controlled clinic BP or white-coat hypertension, target organ damage (proteinuria and left ventricular hypertrophy) was more common in those with elevated nighttime BP, masked hypertension, or sustained hypertension. In conclusion, clinic BP provides an incomplete and potentially misleading assessment of the severity of hypertension in African Americans with hypertensive kidney disease, in large part because of increased nighttime BP. Whether lowering nighttime BP improves clinical outcomes is unknown but should be tested given the substantial burden of BP-related morbidity in this population.

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Section: Discussionmentioning

confidence: 86%

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

et al. 2009

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“…Home blood pressure monitoring in chronic renal failure Patients with a decrease in glomerular filtration rate (GFR) are likely to have co-existing hypertension, including a reduced nocturnal dip in BP and not infrequently higher night-time than daytime BP levels [151][152][153]. This is a common finding also in patients undergoing haemodialysis and continuous ambulatory peritoneal dialysis [154,155] and after renal transplantation [156][157][158].…”

Section: Patients With Arrhythmiasmentioning

confidence: 99%

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

Parati

Stergiou²,

Asmar

et al. 2008

Journal of Hypertension

756

646

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“…Indeed, in renal disease, nondipping is the rule, with a prevalence between 74% and 82%. [25][26][27][28][29] Crosssectional observations have demonstrated that nondippers have more severe morphological 30 and functional 31,32 changes than dippers. Fukuda et al 31 studied subjects with biopsy-proven glomerulopathy and found that creatinine clearance (Cl Cr ) was significantly negatively related to the night/day ratios of both sodium excretion and MAP, whereas Farmer et al 32 have shown that the prevalence of nondipping increases with plasma creatinine concentration in patients with chronic renal insufficiency.…”

Section: Nocturnal Blood Pressure Dipping and Sodium Excretionmentioning

confidence: 99%

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

2006

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M ore than 30 years ago, Guyton 1 described pressurenatriuresis: increasing arterial blood pressure promotes sodium excretion, decreasing blood volume and lowering blood pressure, whereas when blood pressure falls, sodium excretion decreases, and blood volume and blood pressure increase. 1,2 The linchpin of the model of Guyton et al 3 is the concept of feedback gain. Gain is the degree to which a feedback system can correct a perturbation, that is, the amount of correction of a deviation divided by the residual degree of deviation. When a control system corrects a perturbation minimally, its feedback gain is near 0. When it corrects it completely, its gain is infinite. As emphasized by Guyton et al,3 in integrated systems with infinite and finite gain components, the infinite gain function ultimately dominates. There are myriad blood pressure control systems, for example, arterial baroreceptors and chemoreceptors, the central nervous system ischemic response, the renin-angiotensin system, and capillary fluid shift, but all are ultimately trumped by pressure-natriuresis. In the experiments by Guyton et al, 3 pressure-natriuresis had near infinite gain over a wide range of urinary sodium excretion, such that the set point of blood pressure regulation was not affected by sodium intake over a period of several days or a few weeks.This pressure-natriuresis model describes a steady-state relationship. At short time intervals, blood pressure and sodium excretion may not be closely linked, but the body will always eventually bring the system back into balance. In this review, we wish to draw attention to differences in the relationship of blood pressure to sodium excretion during day and night and to how nighttime pressure-natriuresis and sodium sensitivity of blood pressure interact. We will suggest that these features of pressure-natriuresis have implications both for the clinical management of hypertension and research into the genetic underpinnings of the disease. Diurnal Rhythm of Sodium Excretion in Normotensive and Hypertensive SubjectsIn healthy people, sodium excretion reaches a maximum during the day and a minimum at night during sleep, and it has long been thought that blood pressure is the primary determinant of nighttime sodium excretion. 4 -7 Centonza et al 8 performed ambulatory blood pressure monitoring over a 26-hour period in normotensive subjects for whom sodium intake was fixed at a moderate amount (170 mmol/day). All of the subjects demonstrated a nocturnal dip in blood pressure with a concomitant dip in sodium excretion. Moreover, there were significant positive correlations between blood pressure and sodium excretion during the night and over 24 hours, as well as during periods of quiet supine wakefulness and postprandial sitting. No similar relationship was apparent when subjects carried out daily activities in the standing position. The authors concluded that the pressure-natriuresis relationship is blunted during upright posture, possibly because of the activation of neurohumoral systems. 8 St...

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Loss of Nocturnal Decline of Blood Pressure in Hypertension due to Chronic Renal Failure

Cited by 161 publications

References 0 publications

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

Disparate Estimates of Hypertension Control From Ambulatory and Clinic Blood Pressure Measurements in Hypertensive Kidney Disease

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

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