Document Detail

Patients with renal dysfunction require a longer duration until blood pressure dips during the night.
MedLine Citation:
PMID:  18936344     Owner:  NLM     Status:  MEDLINE    
We have postulated that the diminished renal capacity to excrete sodium causes nocturnal blood pressure (BP) elevation, which enhances pressure natriuresis in compensation for impaired daytime natriuresis. If such a mechanism holds, high BP during sleep at night may continue until excess sodium is sufficiently excreted into urine. This study examined whether the duration, defined as "dipping time," until nocturnal mean arterial pressure began to fall to <90% of daytime average became longer as renal function deteriorated. Ambulatory BP measurements and urinary sodium excretion rates were evaluated for daytime and nighttime to estimate their circadian rhythms in 65 subjects with chronic kidney disease. Dipping time showed an inverse relationship with creatinine clearance (C(cr); rho=-0.61; P<0.0001) and positive relationships with night/day ratios of mean arterial pressure (rho=0.84; P<0.0001) and natriuresis (rho=0.61; P<0.0001), both of which were also inversely correlated with C(cr) (mean arterial pressure: r=-0.58, P<0.0001; natriuresis: r=-0.69, P<0.0001). When divided into tertiles by C(cr) (mL/min), hazard ratios of nocturnal BP dip adjusted for age, gender, and body mass index were 0.37 (95% CI: 0.17 to 0.79; P=0.01) for the second tertile (C(cr): 50 to 90) and 0.20 (95% CI: 0.08 to 0.55; P=0.002) for the third tertile (C(cr): 5 to 41) compared with the first tertile (C(cr): 91 to 164). These findings demonstrate that patients with renal dysfunction require a longer duration until BP falls during the night. The prolonged duration until BP dip during sleep seems an essential component of the nondipper pattern of the circadian BP rhythm.
Michio Fukuda; Masashi Mizuno; Tamaki Yamanaka; Masahiro Motokawa; Yuichi Shirasawa; Takae Nishio; Sota Miyagi; Atsuhiro Yoshida; Genjiro Kimura
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-10-20
Journal Detail:
Title:  Hypertension     Volume:  52     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-11-21     Completed Date:  2008-12-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1155-60     Citation Subset:  IM    
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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MeSH Terms
Aged, 80 and over
Blood Pressure / physiology*
Blood Pressure Monitoring, Ambulatory
Chronic Disease
Circadian Rhythm / physiology*
Hypertension, Renal / diagnosis,  epidemiology,  physiopathology*
Kaplan-Meiers Estimate
Kidney / physiology*
Middle Aged
Natriuresis / physiology*
Proportional Hazards Models
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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