Effects of high sodium intake and diuretics on the circadian rhythm of blood pressure in type 2 diabetic patients treated with an angiotensin II receptor blocker

Uzu, Takashi; Sakaguchi, Minoru; Yokomaku, Yukiyo; Kume, Shinji; Kanasaki, Megumi; Isshiki, Keiji; Araki, Shin‐ichi; Sugiomoto, Toshiro; Koya, Daisuke; Haneda, Masakazu; Kashiwagi, Atsunori

doi:10.1007/s10157-009-0157-7

Cited by 29 publications

(28 citation statements)

References 33 publications

(40 reference statements)

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“…Several studies showed that hydrochlorothiazide treatment converted non-dipping hypertensive subjects to dippers. This effect was significant in nondippers but not in dippers [39].…”

Section: Discussionmentioning

confidence: 47%

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TRPV1 activation prevents high-salt diet-induced nocturnal hypertension in mice

Hao

Chen

Luo

et al. 2011

Pflugers Arch - Eur J Physiol

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High dietary salt-caused hypertension is associated with increasing reactive oxygen species generation and reduced nitric oxide (NO) bioavailability. Transient receptor potential vanilloid type 1 (TRPV1), a specific receptor for capsaicin, is proposed to be involved in Dahl salt-sensitive hypertension, as determined in acute or short-term experiments. However, it remains unknown whether activation of TRPV1 by dietary capsaicin could prevent the vascular oxidative stress and hypertension induced by a high-salt diet. Here, we report that consumption of a high-salt diet blunted endothelium-dependent relaxation in mesenteric resistance arteries and elevated nocturnal blood pressure in mice. These effects were associated with increased superoxide anion generation and reduced NO levels in mesenteric vessels in mice on a high-salt diet. However, chronic administration of capsaicin reduced the high-salt diet-induced endothelial dysfunction and nocturnal hypertension in part by preventing the generation of superoxide anions and NO reduction of mesenteric arteries through vascular TRPV1 activation. Our findings provide new insights into the role of TRPV1 channels in the long-term regulation of blood pressure in response to high-salt intake. TRPV1 activation through chronic dietary capsaicin may represent a promising lifestyle intervention in populations with salt-sensitive hypertension.

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“…Several studies showed that hydrochlorothiazide treatment converted non-dipping hypertensive subjects to dippers. This effect was significant in nondippers but not in dippers [39].…”

Section: Discussionmentioning

confidence: 47%

“…There is an interaction between enhanced sodium sensitivity and non-dipping blood pressure in hypertensive patients with metabolic syndrome [38]. Diuretics reproduce the effect of dietary restriction on sodium balance [39]. Several studies showed that hydrochlorothiazide treatment converted non-dipping hypertensive subjects to dippers.…”

Section: Discussionmentioning

confidence: 98%

TRPV1 activation prevents high-salt diet-induced nocturnal hypertension in mice

Hao

Chen

Luo

et al. 2011

Pflugers Arch - Eur J Physiol

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“…[11][12][13][14] It is also well documented that, in patients with sodium sensitive hypertension, the circadian BP rhythm is disturbed by high dietary sodium intake. 15,16 Therefore, the amount of sodium intake may be a determinant of masked hypertension.…”

mentioning

confidence: 98%

High Sodium Intake Is Associated With Masked Hypertension in Japanese Patients With Type 2 Diabetes and Treated Hypertension

Uzu

Nakao

Kume

et al. 2012

American Journal of Hypertension

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“…Because patients with diabetes are salt sensitive, the use of diuretics for natriuresis is also important for controlling nighttime BP and could change the non-dipper pattern to a dipper pattern. 15 Therefore, an antihypertensive treatment that takes into account circadian BP profile might be more effective than the conventional regimen in controlling BP in patients with diabetes. Because individualized therapy is important, ABPM should be performed at least once in all diabetic patients to achieve an improved cardiovascular prognosis.…”

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confidence: 99%

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

Eguchi

2011

Hypertens Res

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H ypertension is one of the most important determinants of micro-and macrovascular complications in patients with diabetes. Recent guidelines on treating hypertension in diabetes patients, based on clinical evidence of protection against target organ damage, especially as demonstrated by renal outcomes, recommended that office blood pressure (BP) be lowered to 130/ 80 mmHg in these patients. 1 However, very few studies have consistently achieved BP levels as low as 130/80 mmHg in diabetic patients.A landmark report related to the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study showed that targeting a systolic BP of o120 mm Hg, as compared with o140 mm Hg, did not reduce the rate of a composite outcome of fatal and non-fatal major cardiovascular events in type 2 diabetics with at high risk for cardiovascular events. 2 As a secondary outcome, intensive BP lowering was effective in reducing total stroke (P¼0.01) and non-fatal stroke events (P¼0.03). 2 Although many observational studies support the 'the lower, the better' theory, it has not been clearly shown that the aggressive lowering of BP is indeed beneficial in the management of hypertension. The ACCORD study was a randomized control study that examined cardiovascular disease as an outcome. The extent of BP lowering in diabetes should be individualized by cardiovascular complications, microvascular complications and the severity of diabetes and hypertension. In the ACCORD subjects, 34% had experienced previous cardiovascular events, and 87% were on antihypertensive medications. The mean baseline BP was as low as 139/76 mmHg in all patients. It is not surprising that no benefit of a further reduction of BP was seen when targeting a systolic BP of o120 mm Hg. In the early stage of diabetes, aggressive control of risk factors could be effective for reducing cardiovascular outcomes. 3,4 In clinical practice, physicians occasionally hesitate to add antihypertensive medications to achieve clinic BP of 130/80 mmHg. The target BP level in patients with diabetes remains to be established. In terms of individualized BP control, ambulatory BP monitoring (ABPM) is the most useful tool for accurately evaluating BP level and variability.For the assessment and management of BP, ABPM is better than clinic BP. 5 ABPM can more reliably and easily assess actual BP levels than clinic BP and is helpful for predicting cardiovascular events, target organ damage and antihypertensive effects. Even in diabetes, we have shown that ambulatory BP levels more accurately predict future cardiovascular events. 5 An abnormal dipping pattern has been established as a risk factor, 6 and white-coat hypertension and masked hypertension have been shown to be moderate risk factors. 7,8 We showed that BP variability during sleep was a risk factor for cardiovascular disease even after adjusting for BP levels in patients with diabetes. 9 Unless ABPM is performed, it is difficult to assess these measures and to perform detailed assessments, especially of nighttime BP. In the meantime, ...

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Effects of high sodium intake and diuretics on the circadian rhythm of blood pressure in type 2 diabetic patients treated with an angiotensin II receptor blocker

Abstract: Excessive intake of salt causes non-dipping and diuretics restored nocturnal BP fall in type 2 diabetic patients treated with angiotensin 2 receptor blockers.

Cited by 29 publications

References 33 publications

TRPV1 activation prevents high-salt diet-induced nocturnal hypertension in mice

TRPV1 activation prevents high-salt diet-induced nocturnal hypertension in mice

High Sodium Intake Is Associated With Masked Hypertension in Japanese Patients With Type 2 Diabetes and Treated Hypertension

A call for wider use of ambulatory blood pressure monitoring in patients with diabetes

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