Nocturnal blood pressure is elevated with natriuresis and proteinuria as renal function deteriorates in nephropathy

Fukuda, Michio; Munemura, Miwa; Usami, Takeshi; Nakao, Naoyuki; Takeuchi, O; Kamiya, Y.; Yoshida, Atsuhiro; Kimura, Genjiro

doi:10.1111/j.1523-1755.2004.00419.x

Cited by 156 publications

(126 citation statements)

References 31 publications

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“…Low eGFR and proteinuria were associated with elevated nighttime BP. These results are consistent with earlier studies in cohorts of patients with CKD, and highlight the importance of ABP rather than home BP in assessing the potential effect of hypertension in patients with CKD (14)(15)(16). Additionally, use of diuretics and angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers was associated with lower nighttime BP.…”

Section: Discussionsupporting

confidence: 91%

“…Cross-sectional analyses in patients with normal renal function show that elevated nighttime BP is associated with both greater pulse wave velocity (PWV) and LVH (3,12,13). A few small studies of patients with CKD have shown that both decreased eGFR and proteinuria are associated with elevated nighttime BP (14)(15)(16). The mechanism by which CKD leads to elevated nighttime BP is not well understood but is likely multifactorial, and includes volume-dependent hypertension exacerbated by recumbent posture, abnormal sodium handling, and comorbidities such as diabetes and autonomic insufficiency.…”

Section: Introductionmentioning

confidence: 99%

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Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

173

118

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Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. ResultsThe percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (23.2 ml/min per 1.73 m 2 ; 95% confidence interval, 25.5 to 20.9), higher proteinuria (+0.9 unit higher in log 2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m 2.7 ; 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (23.6 ml/min per 1.73 m 2 ; 95% confidence interval, 26.1 to 21.1; versus 21.4 ml/min per 1.73 m 2 ; 95% confidence interval, 26.9 to 4.0, among those with nighttime BP ,120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).Conclusions Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

173

118

View full text Add to dashboard Cite

show abstract

“…Previous studies revealed that the RI was a useful predictor of renal dysfunctions [11][12][13][14][15][16] and correlated significantly with organ damage. Measurement of RI in addition to low-grade albuminuria is reportedly useful for target organ damage screening in patients with resistant Blood pressure variability and renal function T Kawai et al hypertension.…”

Section: Discussionmentioning

confidence: 98%

“…[11][12][13][14][15][16] We previously reported that the RI might be a more efficacious parameter for the evaluation of very early renal damage than estimated glomerular filtration rate (eGFR). 17 It is thought that renal vascular damage caused by atherosclerotic risk factors such as hypertension and variability of BP could be evaluated more precisely by the RI.…”

Section: Introductionmentioning

confidence: 99%

The impact of visit-to-visit variability in blood pressure on renal function

et al. 2011

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Hypertension is an important risk factor for cardiovascular diseases such as chronic kidney disease. It is still not fully understood how blood pressure impacts the kidneys. In this study, we aimed to establish the significance of visit-to-visit variability in blood pressure for renal function. We analyzed 143 consecutive patients undergoing renal Doppler ultrasonography in our hospital ward and measured blood pressure at outpatient visits six or more times. We analyzed the correlation between visit-to-visit variability in blood pressure and multiple clinical parameters, including albuminuria and resistive index evaluated by renal Doppler ultrasonography, which is thought to be a good indicator of renal vascular resistance. Subjects with higher variability in systolic blood pressure showed a significantly higher prevalence rate of clinical albuminuria and microalbuminuria, and showed significantly higher resistive index. Stepwise multiple regression analysis showed that variability in systolic blood pressure was a significant risk factor for higher resistive index, independent of other renal risk factors. Visit-to-visit variability in blood pressure correlates significantly with renal function and renal arteriosclerotic change. This parameter could provide additional information about renal arteriosclerotic change independent of estimated glomerular filtration rate and albuminuria, and should be considered a therapeutic target for renal protection.

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“…[4][5][6] Chronic kidney disease (CKD) seems to be tightly linked with nocturnal hypertension and morning BP surge. 7 CKD poses a high risk for the onset of cardiovascular disease. Early detection and appropriate treatment delays the progression of kidney disease and prevents the incidence of cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

et al. 2010

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Chronic kidney disease (CKD) is common disease in patients with sleep apnea syndrome (SAS), which is considered to be responsible for secondary and nocturnal hypertension. In this study, we assessed blood pressure (BP) changes in SAS patients with CKD. Of 460 Japanese outpatients with suspected SAS who underwent ambulatory BP monitoring within 3 months of overnight polysomnography, 198 patients (172 males and 26 females) who were not receiving treatment with antihypertensives or nitroglycerin were enrolled. The estimated glomerular filtration rate (eGFR) was calculated, and the patients were stratified into the high (H; eGFRX60 ml min À1 per 1.73 m 2 ) or the low (L; eGFRo60 ml min À1 per 1.73 m 2 ) group. The patients in the L group were significantly older than those in the H group (Po0.001), and body mass index was significantly smaller in the L group than in the H group (P¼0.025). The rate of patients treated with statin (P¼0.030) and the levels of both triglyceride (P¼0.006) and creatinine (Po0.001) differed significantly between the two groups. The sleep data, 24-h BP, awake BP and morning BP showed no significant differences between the two groups. However, sleep systolic and diastolic BPs were significantly higher in the L group (122.5±16.7 mm Hg and 81.1±12.2 mm Hg, respectively) than in the H group (117.1±11.8 mm Hg, P¼0.033; and 76.1±9.5 mm Hg, P¼0.012, respectively). SAS patients with CKD had elevated sleep BP. This result suggests that appropriate treatments for both SAS and CKD prevent sleep BP elevation, which is considered a risk factor for the onset risk of a cardiovascular event. Keywords: ambulatory blood pressure monitoring; circadian blood pressure; estimated glomerular filtration rate; nocturnal hypertension; polysomnography INTRODUCTIONIt is important to consider blood pressure (BP) outside of a clinic setting when treating patients with hypertension, because BP measurements obtained in a clinic setting are not representative of BP outside of the clinic setting. Abnormal changes in circadian BP are considered to increase the risk of cardiovascular event. Patients with nocturnal hypertension or a morning BP surge tend to have a higher incidence of silent cerebrovascular disease 1 and greater intima-media and relative wall thickness compared with normotensive patients. 2 Nocturnal hypertension and morning BP surge are induced by sleep disordered breathing, which can be observed in 22% of Japanese adult males. 3 Typical clinical features of BP changes in patients with sleep disordered breathing and those with sleep apnea syndrome (SAS) are nocturnal hypertension and non-dipper patterns of circadian BP. As the severity of SAS increases, sleep BP is elevated even in a patient whose BP is within the normal range in the clinic. Moreover, the incidence of nocturnal cardiovascular events while sleeping increases in these patients. [4][5][6] Chronic kidney disease (CKD) seems to be tightly linked with nocturnal hypertension and morning BP surge. 7 CKD poses a high risk for the onset of cardiovascu...

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Nocturnal blood pressure is elevated with natriuresis and proteinuria as renal function deteriorates in nephropathy

Cited by 156 publications

References 31 publications

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

The impact of visit-to-visit variability in blood pressure on renal function

Relationship between chronic kidney disease and sleep blood pressure in patients with sleep apnea syndrome

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