Morning hypertension in chronic kidney disease is sustained type, but not surge type

Mizuno, Masashi; Fukuda, Michio; Miura, Toshiyuki; Wakamatsu, Tamaki; Naitô, Takeshi; Sato, Ryo; Togawa, H.; Sasakawa, Yuji; Tomonari, Tatsuya; Ono, Minamo; Kato, Yoko; Ichikawa, Tadashi; Shirasawa, Yuichi; Ito, Akinori; Yoshida, Atsuhiro; Kimura, Genjiro

doi:10.1097/mbp.0b013e32835026c6

Cited by 9 publications

(2 citation statements)

References 13 publications

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“…[ 17 ] HBI and PTE[ 9 ] were significantly higher at nighttime than daytime in resistant HTN patients. In our study we found that total 38 patients out of 192 patients were having Early Morning Surge (19.79%), out of which 3 patients were in stage IV and 35 patients were in stage V. A study by Mizuno N in 2012,[ 18 ] suggested that the morning rise of BP in CKD patient is sustained type, that is, nocturnal blood pressure is elevated but not meeting the criteria for surge.…”

Section: Discussionmentioning

confidence: 53%

Clinical Utility of 24-h Ambulatory Blood Pressure Monitoring in Hospitalized Patients with Chronic Kidney Disease

Salagre¹,

Ansari²,

Mali³

2021

Indian J Nephrol

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Introduction: Hypertension leads to rapid progression of kidney disease. Hypertension (HTN) is the second most common cause for CKD after diabetes. Ambulatory blood pressure monitoring (ABPM) helps in accurate and early diagnosis of HTN along with measurements of other variables, namely nondippers, reverse dippers, hyperbaric index (HBI), percentage time elevation (PTE), and early morning surge. Methodology: After obtaining the institution ethics committee approval total 192 cases, of 12–80 years age group, who were diagnosed with CKD were included in the study. ABPM was done for patients using Meditech ABPM-05 machine. Results: Study showed male predominance. Maximum patients were in the age group of 41–60 years. Prevalence of Hypertension in patients with CKD was 88.02%. The systolic BP, diastolic BP, and mean arterial pressure (MAP) were significantly higher by clinic BP measurement than ABPM in all stages of patients with CKD especially in stage IV than stage V CKD. Systolic, diastolic, MAP, HBI and PTE at nighttime were significantly higher than daytime in all patients with CKD, especially in patients with resistant hypertension. Prevalence of whitecoat HTN (4.1%), whitecoat effect (16.1%), resistant hypertension (39.6%), masked HTN (1%), and masked uncontrolled HTN (10.4%) was noted. Systolic and diastolic HBI was lower in patients on hemodialysis as compared to those not on hemodialysis. Non-dippers were more than dippers. Conclusion: Apart from mean systolic and diastolic BP, ABPM gives the extent of end-organ damage and insights into the need for control of 24 h BP in patients of CKD.

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Section: Discussionmentioning

confidence: 53%

Clinical Utility of 24-h Ambulatory Blood Pressure Monitoring in Hospitalized Patients with Chronic Kidney Disease

Salagre¹,

Ansari²,

Mali³

2021

Indian J Nephrol

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“…There appears to be a strong link between CKD and alterations to diurnal blood pressure rhythms. Patients with CKD have been demonstrated to have higher incidence of nocturnal hypertension, non-dipping, and altered peak timing of blood pressure rhythms (Portaluppi et al, 1990;Portaluppi et al, 1991;Farmer et al, 1997;Agarwal et al, 2009;Mizuno et al, 2012;Mojon et al, 2013). Dhaun et al (2014) recently provided evidence that blood pressure lowering in CKD may be able to restore diurnal variations in blood pressure.…”

Section: Chronic Kidney Disease and Nervesmentioning

confidence: 99%

Autonomic nerves and circadian control of renal function

Becker¹,

Zhang²,

Soliman³

et al. 2019

Autonomic Neuroscience

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Cardiovascular and renal physiology follow strong circadian rhythms. For instance, renal excretion of solutes and water is higher during the active period compared to the inactive period, and blood pressure peaks early in the beginning of the active period of both diurnal and nocturnal animals. The control of these rhythms is largely dependent on the expression of clock genes both in the central nervous system and within peripheral organs themselves. Although it is understood that the central and peripheral clocks interact and communicate, few studies have explored the specific mechanism by which various organ systems within the body are coordinated to control physiological processes. The renal sympathetic nervous innervation has long been known to have profound effects on renal function, and because the sympathetic nervous system follows strong circadian rhythms, it is likely that autonomic control of the kidney plays an integral role in modulating renal circadian function. This review highlights studies that provide insight into this interaction, discusses areas lacking clarity, and suggests the potential for future work to explore the role of renal autonomics in areas such as blood pressure control and chronic kidney disease.

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Clinical value of ambulatory blood pressure: Is it time to recommend for all patients with hypertension?

et al. 2015

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Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat hypertension, and fewer false negatives by detecting more masked hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking antihypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical complications of hypertension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing hypertension.

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Morning hypertension in chronic kidney disease is sustained type, but not surge type

Abstract: Sustained elevation of night-time BP until the early morning and high night/day ratio of BP may contribute to the high frequency of morning hypertension, which is generally the sustained rather than the surge type in CKD.

Cited by 9 publications

References 13 publications

Clinical Utility of 24-h Ambulatory Blood Pressure Monitoring in Hospitalized Patients with Chronic Kidney Disease

Clinical Utility of 24-h Ambulatory Blood Pressure Monitoring in Hospitalized Patients with Chronic Kidney Disease

Autonomic nerves and circadian control of renal function

Clinical value of ambulatory blood pressure: Is it time to recommend for all patients with hypertension?

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