Circadian rhythm of natriuresis is disturbed in nondipper type of essential hypertension

Fujii, Takashi; Uzu, Takashi; Nishimura, Masataka; Takeji, Masanobu; Kuroda, Setsuko; Nakamura, Satoko; Inenaga, Takashi; Kimura, Genjiro

doi:10.1016/s0272-6386(99)70254-4

Cited by 156 publications

(118 citation statements)

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“…Because higher nighttime blood pressure is associated with greater sodium excretion, dippers and nondippers should have different circadian rhythms of sodium output. Fujii et al 23 addressed this issue in a study of essential hypertensive subjects maintained on high-or low-sodium diets, each for 1 week. Eight patients were classified as dippers based on a fall in MAP of Ͼ10% from day to night on the high-sodium diet; the rest were nondippers.…”

Section: Nocturnal Blood Pressure Dipping and Sodium Excretionmentioning

confidence: 99%

“…Fujii et al 23 reported that creatinine excretion rate (milligrams per hour) increased from day to night in nondippers on a high-sodium diet (48Ϯ19 to 51Ϯ22 mg/h) but decreased during a low-sodium diet (49Ϯ20 to 45Ϯ21 mg/h). In dippers, creatinine excretion rate decreased from day to night on both high-and low-sodium diets (64Ϯ28 to 56Ϯ40 mg/h) on high sodium (58Ϯ15 to 46Ϯ13 mg/h on low sodium).…”

Section: Sachdeva and Weder Nocturnal Na Excretion And Bp Dipping 529mentioning

confidence: 99%

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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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Section: Nocturnal Blood Pressure Dipping and Sodium Excretionmentioning

confidence: 99%

Section: Sachdeva and Weder Nocturnal Na Excretion And Bp Dipping 529mentioning

confidence: 99%

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

2006

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“…Under usual circumstances, BP is normally lowest at night as is sodium excretion. However, in acute and chronic situations when sodium intake is excessive or its excretion hampered during the daytime, BP is adjusted by means of the pressure/natriuresis mechanism to the higher level needed to compensate overnight, thereby resulting in non-dipping 24-h patterning (Bankir et al, 2008;Fujii et al, 1999;Uzu et al, 2001). This is the reason why sodium-sensitive hypertensives, i.e., patients prone to retain sodium to such a degree that BP is significantly increased, tend to be non-dippers.…”

Section: Mechanisms Underlying the Advantage Of Bedtime Chronotherapymentioning

confidence: 99%

Perspectives on the Chronotherapy of Hypertension Based on the Results of the Mapec Study

Portaluppi

Smolensky

2010

Chronobiology International

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Appreciation of chronotherapy in hypertension continues to lag, despite clear demonstrations by many studies of (i) clinically relevant dosing-time differences of the beneficial and adverse effects of most blood pressure (BP) medications and (ii) significant association between reduced sleep-time BP decline of non-dippers and their heightened risk of cardiovascular disease (CVD). The Syst-Eur and HOPE outcome trials showed evening administration of nitrendipine and ramipril in these respective studies impacts sleep-time BP, converting the 24-h BP pattern to a more dipper one and in the HOPE study decreasing CVD risk. The CONVINCE study intended to compare BP control and CVD protection afforded by conventional β-blocker and diuretic medications versus a special drug-delivery verapamil formulation as a bedtime hypertension chronotherapy; however, the trial was terminated prematurely, not based on inadequate performance of the chronotherapy but on a corporate business decision. The just completed MAPEC study is the first trial specifically designed to prospectively test the hypothesis that bedtime administration of ≥1 conventional medications exerts better BP control and CVD risk reduction than the traditional approach of scheduling all medications in the morning. The results of this 5.6-yr median follow-up study establish that bedtime chronotherapy more effectively improves BP control, better decreases prevalence of non-dipping, and, most importantly, best reduces CVD morbidity and mortality. This chronotherapeutic approach to hypertension is justified by the fact that BP is usually lowest at night as is sodium excretion, but when sodium intake is excessive or its daytime excretion hampered, nocturnal BP is adjusted higher, to a level required for compensation overnight, via the pressure/natriuresis mechanism, resulting in non-dipping 24-h BP patterning. In diurnally active persons, the entire circadian BP pattern may be reset to a lower mean level and to a "more normal" day-night variation, simply by enhancing natriuresis during the night-the time-of-day when it can be most effective. A modification as simple and inexpensive as switching ≥1 hypertension medications from morning 1652 Address correspondence to Francesco Portaluppi, MD, Hypertension Center, Department of Medicine, University Hospital "S. Anna" of Ferrara, Corso Giovecca 203, I-44100 Ferrara, Italy. Tel: +39 0532 236631; Fax: +39 0532 236622; E-mail: prf@unife.it Submitted July 10, 2010, Returned for revision July 17, 2010, Accepted July 20, 2010 Chronobiology International, 27(8): 1652-1667 Copyright © 2010 Informa Healthcare USA, Inc. ISSN 0742-0528 print/1525-6073 online DOI: 10.3109/07420528.2010.510788 to evening may be all that is needed to normalize nighttime BP, exerting an effect exactly like sodium restriction. Current clinical concepts such as "normotensive nondipper" (with higher CVD risk than a hypertensive dipper), broad recommendation of pharmacotherapy with exclusively high "smoothness index" medications (without attention to ind...

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“…Another factor that seems to exert influence on ND phenomenon is sodium ingestion 31 . Some studies reported that ND would be associated to a reduced excretion of sodium during vigil period 32,33 . Birkenhäger and van den Meiracker 34 observed that a low sleep quality, along with daily inactivity, represented by sedentarism, might explain the phenomenon of ND absence.…”

Section: Dm -Diabetes Mellitus; MI -Myocardium Infarction; Dlp -Dislimentioning

confidence: 99%

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio

Vaz-de-Melo¹,

Loureiro²,

Cipullo³

et al. 2010

Arq. Bras. Cardiol.

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Circadian rhythm of natriuresis is disturbed in nondipper type of essential hypertension

Cited by 156 publications

References 30 publications

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

Nocturnal Sodium Excretion, Blood Pressure Dipping, and Sodium Sensitivity

Perspectives on the Chronotherapy of Hypertension Based on the Results of the Mapec Study

Ausência de descenso noturno se associa a acidente vascular cerebral e infarto do miocárdio

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