Blood Pressure Elevation during the Night in Chronic Renal Failure, Hemodialysis and after Renal Transplantation

Baumgart, Peter; Walger, Peter; Gemen, S; Eiff, M. von; Raidt, H; Rahn, K H

doi:10.1159/000186278

Cited by 146 publications

(60 citation statements)

References 18 publications

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“…[47][48][49][50][51][52] Because the degree of non-dipping was closely correlated with the degree of renal function loss, as discussed above, 38,40 however, non-dipping might be consequently correlated with the progression of nephropathy. Our clear results especially obtained after kidney donation 40 that instead it might be a phenotype of renal functional loss, together with well known facts that in patients with renal dysfunction the nocturnal BP dip is lost and circadian rhythms manifest as those of non-dippers, 38,40,47,50,53,54 suggest that the circadian rhythm of BP is determined mostly by the kidneys. The importance of kidneys in the genesis of circadian BP rhythm is consistent with reports that the circadian rhythm of BP is normalized from non-dipper to dipper after kidney transplantation, 55 and also by salt intake restriction and diuretics.…”

Section: Salt Sensitivity and Circadian Rhythm Of Blood Pressuresupporting

confidence: 53%

Salt sensitivity and circadian rhythm of blood pressure: the keys to connect CKD with cardiovasucular events

2010

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In healthy subjects, blood pressure (BP) drops by 10-20% during the night. Conversely, in patients with the salt-sensitive type of hypertension or chronic kidney disease, nighttime BP does not fall, resulting in an atypical pattern of circadian BP rhythm that does not dip. This pattern is referred to as the 'non-dipper' pattern. Loss of renal functional reserve, due to either reduced ultrafiltration capacity or enhanced tubular sodium reabsorption, induces the salt-sensitive type of hypertension. When salt intake is excessive in patients with salt-sensitive hypertension, the defect in sodium excretory capability becomes evident, resulting in elevated BP during the night. This nocturnal hypertension compensates for diminished natriuresis during the daytime and enhances pressure natriuresis during the night. Nocturnal hypertension and the non-dipper pattern of circadian BP rhythm cause cardiovascular events. When excess salt intake is loaded in patients who are in a salt-sensitive state, glomerular capillary pressure is also elevated, resulting in glomerular sclerosis and eventual renal failure. In this way, salt sensitivity and excess salt intake contribute to both cardiovascular and renal damage at the same time. We propose that salt sensitivity of BP and excess salt intake have important roles in the genesis of the cardiorenal connection. Salt sensitivity and circadian rhythm of BP are the keys to understanding the connections between cardiovascular and renal complications.

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Section: Salt Sensitivity and Circadian Rhythm Of Blood Pressuresupporting

confidence: 53%

Salt sensitivity and circadian rhythm of blood pressure: the keys to connect CKD with cardiovasucular events

2010

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“…Fromthese results, sympathetic activity was found to be a contributor to hypertension in chronic renal insufficiency as Ligtenberg et al recently confirmed (34). Similar findings were also reported by Baumgart et al (32), who demonstrated significantly lower differences in blood pressure between the awake and sleeping time in patients with chronic renal insufficiency compared to control subjects. From these studies, it is suggested that somesubjects with predialysis renal disease may have hidden hypertension at night.…”

Section: Aggressive Blood Pressure Reduction In Patients With Chronicsupporting

confidence: 82%

“…This phenomenonis usually recognized as morning surge of blood pressure. Accumulative evidence clearly demonstrate that ambulatory blood pressure levels, compared with office blood pressure levels, are moreclosely related to hypertensive organ damage (27)(28)(29)(30)(31)(32). Portaluppi et al (29) monitored blood pressure in 30 hospitalized hypertensive patients (mean age, 45 years) who were not undergoing dialysis but had advanced renal disease (mean creatinine clearance, 25 ml/min) and in 30 matched essential hypertensive patients with normal renal function (creatinine clearance 1 14 ml/min).…”

Section: Aggressive Blood Pressure Reduction In Patients With Chronicmentioning

confidence: 99%

Treatment of Hypertension in Chronic Renal Insufficiency.

Suzuki

2000

Intern. Med.

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Hypertensionis the most common complication of chronic renal insufficiency (CRI) and it accelerates the rate of progression of most forms of CRI. Several large clinical trials have clearly demonstrated the efficacy of antihypertensive treatment for prevention of progression of renal failure. Angiotensin-converting enzyme (ACE) inhibitors may have therapeutic advantages. However, large scale trials include a variety of chronic renal diseases, and the origins of renal diseases are quite diverse. Moreover, the differences in sex, age, race have not been considered. Based on these trials, it was concluded that blood pressure control is the most effective meansfor the prevention of deterioration of renal dysfunction. Consistent with this view, our recent preliminary data provide evidence that aggressive blood pressure control using self-reported blood pressure values measured by a home blood pressure device is promising to arrest the progression of renal failure in Japanese patients with CRI.

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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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Blood Pressure Elevation during the Night in Chronic Renal Failure, Hemodialysis and after Renal Transplantation

Cited by 146 publications

References 18 publications

Salt sensitivity and circadian rhythm of blood pressure: the keys to connect CKD with cardiovasucular events

Salt sensitivity and circadian rhythm of blood pressure: the keys to connect CKD with cardiovasucular events

Treatment of Hypertension in Chronic Renal Insufficiency.

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

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