Reduction in Morning Blood Pressure Is a Key Factor for Ameliorating Urinary Albumin Excretion in Patients With Morning Hypertension Irrespective of Treatment Regimen

Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp (NO), a vasodilator, regulates endothelial function and blood pressure (BP). Our previous review indicated emerging evidence supporting that a deficiency of NO links endothelial dysfunction to CVD in pediatric CKD. 3 Because asymmetric dimethylarginine (ADMA) is an analog of L-arginine (ARG), the substrate for NO synthase (NOS), the ARG-to-ADMA ratio (AAR) represents NO bioavailability and maintains NO homeostasis. 4 Elevated plasma ADMA levels are observed in patients with hypertension (HT) as well as CKD. 5,6 Ambulatory BP monitoring (ABPM) has proven to be the best method of detecting abnormal BP and cardiovascular outcome in CKD. 7 Our recent reports showed that ARG metabolites in the NO pathway are interrelated and involved in abnormal ABPM profiles in children with CKD. 8,9 ADMA is synthesized by the ardiovascular disease (CVD) is a major cause of morbidity and mortality in children and adults with chronic kidney disease (CKD). 1 Unlike adults, young CKD patients rarely present with CV events. Thus assessment of CVD in childhood mainly relies on the characteristics of vascular phenotype. Less attention has been paid to evaluating subclinical CVD in the early stage of CKD in the pediatric population. It is noteworthy that CKD children with subclinical CVD are at risk of subsequent development of CVD in adulthood. Thus, identification of surrogate markers to detect subclinical CVD in early CKD children may aid in reducing the global burden of CKD.Deterioration in endothelial function and arterial stiffness are early events in the development of CVD. Background: Less attention has been paid to evaluating subclinical cardiovascular disease (CVD) in the early stage of pediatric chronic kidney disease (CKD). Ambulatory blood pressure monitoring (ABPM) and arterial stiffness are the earliest detectable assessments of subclinical CVD. Asymmetric dimethylarginine (ADMA) is an analog of L-arginine (ARG) that inhibits nitric oxide (NO) production; thus the ARG-to-ADMA ratio (AAR) is an index of NO. Homocysteine (HCY) is a risk factor for CVD and it can be metabolized to L-cysteine (CYS). Given that HCY and ADMA/NO are closely linked and related to hypertension, we therefore investigated whether ARG and HCY metabolites, arterial stiffness parameters, ABPM profile, and left ventricular hypertrophy (LVH) are interrelated in children and adolescents with early CKD.

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“…Our data support the findings of previous studies showing that hyperuricemia is common in pediatric CKD and related to high BP. [33][34][35] …”

Section: Discussionmentioning

confidence: 99%

Homocysteine and Arginine-to-Asymmetric Dimethylarginine Ratio Associated With Blood Pressure Abnormalities in Children With Early Chronic Kidney Disease

Chien

Lin

Hsu

et al. 2015

Circ J

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“…Of particular note, in 25 patients with isolated morning hypertension, BP was controlled in nine of the 11 patients in the losartan/hydrochlorothiazide 50/12.5 mg combination group and in three of the 14 patients in the losartan 100 mg/d group (81.8% vs 21.4%; P = .003). Irrespective of treatment regimen, reduction in morning BP was associated with a significant reduction in urinary albumin excretion . In another randomized, double‐blind, parallel group study (n = 626), the combination of olmesartan/amlodipine was more effective in reducing BP over 24 hours, including the early morning and whole morning hours than those who were not adequately controlled with amlodipine monotherapy ( P < .0001) .…”

Section: Treatment Of Morning Hypertensionmentioning

confidence: 98%

Management of morning hypertension: a consensus statement of an Asian expert panel

Wang

Kario

Chen

et al. 2018

J of Clinical Hypertension

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“…Because diuretics are reported to improve nocturnal hypertension, regression of LVH can be attributed to changes in nighttime and morning BP by HCTZ administration. 30, 31 On the other hand, a statistically significant decrease was observed in the serum sodium and potassium levels in the losartan/ HCTZ group, an observation reported previously and considered clinically insignificant. 8, 32 It is clear, however, that diuretics should be avoided in the presence of hyponatremia or hypokalemia, 33 though these disorders are rare among patients who eat a balanced diet.…”

Section: Changes In Laboratory Measurementsmentioning

confidence: 67%

Regression of Electrocardiographic Signs of Left Ventricular Hypertrophy by Combined Treatment With Thiazide Diuretic and Angiotensin-II Receptor Blocker

Sawa

Sato

Matsuda

et al. 2014

Circ J

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Reduction in Morning Blood Pressure Is a Key Factor for Ameliorating Urinary Albumin Excretion in Patients With Morning Hypertension Irrespective of Treatment Regimen

Cited by 10 publications

References 18 publications

Homocysteine and Arginine-to-Asymmetric Dimethylarginine Ratio Associated With Blood Pressure Abnormalities in Children With Early Chronic Kidney Disease

Homocysteine and Arginine-to-Asymmetric Dimethylarginine Ratio Associated With Blood Pressure Abnormalities in Children With Early Chronic Kidney Disease

Management of morning hypertension: a consensus statement of an Asian expert panel

Regression of Electrocardiographic Signs of Left Ventricular Hypertrophy by Combined Treatment With Thiazide Diuretic and Angiotensin-II Receptor Blocker

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