Document Detail


Nocturnal blood pressure dipping in the hypertension of autonomic failure.
MedLine Citation:
PMID:  19047577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Blood pressure (BP) normally decreases during the night. Absence of this phenomenon (nondipping) is associated with increased cardiovascular risk. Altered autonomic and endocrine circadian rhythms are suspected to play a role. Patients with peripheral autonomic failure offer a unique opportunity to study this phenomenon, because approximately 50% develop supine hypertension despite very low autonomic function. The purpose of this study was to define the prevalence of dipping in these patients and to determine whether dipping is associated with less severe autonomic impairment or exaggerated nocturnal sodium excretion. We collected BP and urine from 8:00 pm to 8:00 am in 41 peripheral autonomic failure patients with supine hypertension. Dipping (systolic BP fall >or=10% during 12 am to 6 am from baseline [8 pm to 10 pm]) occurred in 34% of patients, with an average decrease of -44+/-4 mm Hg at 4 am. Systolic BP, averaged from 12 am to 6 am, decreased to normotensive levels in 50% (n=7) of dippers and 15% (n=7) of nondippers. There were no significant differences in the severity of autonomic failure, nocturnal diuresis, or natriuresis (0.18+/-0.01 in dippers versus 0.18+/-0.01 mEq/mg of creatinine in nondippers; P=0.522) between groups. At 8:00 am, orthostatic hypotension was similar between groups (-84/-35+/-9/4 mm Hg in dippers versus -93/-39+/-6/3 mm Hg in nondippers; P=0.356 for systolic BP). In conclusion, dipping was observed in one third of patients with peripheral autonomic failure, so that a significant percentage of patients would not require treatment for supine hypertension. Dipping was not associated with increased nocturnal urinary sodium or volume excretion or less severe autonomic failure. Thus, mechanisms independent of autonomic pathways contribute to BP dipping in these patients.
Authors:
Luis E Okamoto; Alfredo Gamboa; Cyndya Shibao; Bonnie K Black; André Diedrich; Satish R Raj; David Robertson; Italo Biaggioni
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2008-12-01
Journal Detail:
Title:  Hypertension     Volume:  53     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2009 Feb 
Date Detail:
Created Date:  2009-01-23     Completed Date:  2009-02-13     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  363-9     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Autonomic Nervous System / physiopathology*
Blood Pressure / physiology*
Circadian Rhythm / physiology*
Creatinine / urine
Female
Humans
Hypertension / drug therapy,  physiopathology*,  urine
Male
Nitroglycerin / therapeutic use
Sodium / urine
Vasodilator Agents / therapeutic use
Grant Support
ID/Acronym/Agency:
K23 RR020783/RR/NCRR NIH HHS; KL2 RR024977/RR/NCRR NIH HHS; KL2 TR000446/TR/NCATS NIH HHS; P01 HL056693/HL/NHLBI NIH HHS; P01 HL056693-120004/HL/NHLBI NIH HHS; P01 HL56693/HL/NHLBI NIH HHS; R01 HL071784/HL/NHLBI NIH HHS; R01 HL071784-05A1/HL/NHLBI NIH HHS; R01 NS055670/NS/NINDS NIH HHS; R01 NS055670/NS/NINDS NIH HHS; R01 NS055670-03/NS/NINDS NIH HHS; TL1 RR024978/RR/NCRR NIH HHS; TL1 TR000447/TR/NCATS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 RR024975-01/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 9NEZ333N27/Sodium; AYI8EX34EU/Creatinine; G59M7S0WS3/Nitroglycerin
Comments/Corrections

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