Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients

Liu, Manchang; Takahashi, Hiroshi; Morita, Yoshiharu; Maruyama, Shoichi; Mizuno, Masashi; Yuzawa, Yukio; Watanabe, M; Toriyama, Takanobu; Kawahara, Hirohisa; Matsuo, Seiichi

doi:10.1093/ndt/18.3.563

Cited by 209 publications

(156 citation statements)

References 19 publications

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“…It is well known, indeed, that patients with PA loose blood pressure circadian rhythm and become non-dipper, a condition associated with an increased risk for cardiovascular events (36,37). In our patients, 24 h blood pressure monitoring showed that after surgery patients with small adenoma restored blood pressure circadian rhythm at variance with patients with a bigger adenoma.…”

Section: Discussionsupporting

confidence: 50%

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Giacchetti¹,

Ronconi²,

Rilli³

et al. 2009

European Journal of Endocrinology

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Objective: Primary aldosteronism (PA) due to aldosterone-producing adenoma (APA) is the most common curable form of secondary hypertension. Design: In order to evaluate blood pressure outcome after adrenalectomy for APA and to identify new favorable prognostic factors, data from 42 consecutive APA patients who underwent adrenalectomy were collected from 2005 to 2007. Methods: Renin-angiotensin-aldosterone system (upright and postsaline infusion test), serum and urinary electrolytes, office and ambulatory blood pressure monitoring were evaluated at baseline and after a follow-up of 2.7G2.2 years. Drug history and adenoma size at morphological evaluation were also collected. Results: Multiple regression analysis showed that, before surgery, patients with a small adenoma (diameter !20 mm) displayed higher postsaline aldosterone values (PZ0.0001), and lower serum potassium levels (PZ0.020), than patients with adenoma O20 mm. Before surgery, mineralocorticoid receptor (MR) antagonists were used in patients with small APA in greater percentage than patients with bigger adenomas (64 vs 30% respectively, PZ0.037). At follow-up, blood pressure normalized in 63% of the subjects. Recovered patients had a shorter duration of hypertension (PZ0.038), and a smaller adenoma size (PZ0.035). Receiver operating characteristic curves showed that a duration of hypertension %6 years and an APA size !20 mm were the best predictors of blood pressure normalization. Patients with APA !20 mm showed the complete restoration of blood pressure circadian rhythm. Conclusions: The presence of APA !20 mm, duration of hypertension equal or less than 6 years, and preoperative MR antagonists use are favorable prognostic factors for hypertension recovery after adrenalectomy.

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Section: Discussionsupporting

confidence: 50%

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Giacchetti¹,

Ronconi²,

Rilli³

et al. 2009

European Journal of Endocrinology

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“…22 Another prospective study found higher rates of cardiovascular mortality and coronary artery stenosis in ND patients compared to D patients undergoing HD. 23 Based on these studies and our results, we suggest that a deteriorated diurnal blood pressure rhythm parallels the malnutrition status in patients undergoing HD. Interestingly, which is an indicator of hypervolemia, cardiothoracic index of the patients with ND and RD pattern was significantly higher than patients with D pattern.…”

Section: Discussionsupporting

confidence: 71%

“…Related studies have revealed that nighttime blood pressure is associated with LVH [18][19][20][21] and is a predictor of negative cardiovascular outcomes in patients undergoing HD. 22,23 One study reported that cardiovascular survival was worse in patients with the ND blood pressure pattern compared to patients with the D blood pressure pattern, and it stated that an elevated 24 h pulse pressure and nighttime systolic blood pressure were associated with cardiovascular mortality. 22 Another prospective study found higher rates of cardiovascular mortality and coronary artery stenosis in ND patients compared to D patients undergoing HD.…”

Section: Discussionmentioning

confidence: 99%

Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysis

et al. 2013

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“…In addition, patients with secondary hypertension (2), autonomic failure (3), and chronic renal failure (CRF) (4) are particularly prone to loss of circadian BP rhythmicity, which also relates to their cardiovascular prognosis (5). In patients with CRF, derangements of diurnal BP rhythmicity have been associated with the degree of renal dysfunction (6), the rate of progression of renal failure (7), and with changes in the autonomic nervous system (5,8).…”

mentioning

confidence: 99%

Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

Wühl

Hadtstein

Mehls

et al. 2005

Journal of the American Society of Nephrology

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Whereas the diurnal fall of BP (dipping) is an important prognostic marker in patients with chronic renal failure (CRF), the integrity of physiologic ultradian (i.e., shorter than 24 h) cardiovascular rhythms in patients with CRF is unknown. Also, the relationship between conventional dipping analysis and Fourier spectral rhythm analysis has not been examined in renal hypertension. The prevalence and dimensions of the circadian and three ultradian (12, 8, and 6 h) cardiovascular rhythms were studied by ambulatory BP monitoring in 214 children (aged 3 to 18 yr) with CRF (stage 2 to 4 chronic kidney disease) and no antihypertensive treatment compared with 938 healthy control subjects, and the relationship of rhythm characteristics to conventional dipping parameters, renal function, proteinuria, and serum electrolytes was assessed. The CRF cohort exhibited significantly reduced amplitudes of the circadian and all ultradian cardiovascular rhythms studied (all P < 0.01). Moreover, all BP and most heart rate rhythms showed significantly delayed acrophases (time of peak; P < 0.01). Whereas conventional BP dipping parameters (day/night difference, day/night ratio) and the 24-h BP amplitude were independent of renal function, the 8-h BP amplitude was positively correlated with GFR (r ‫؍‬ 0.3, P ‫؍‬ 0.01) and inversely correlated with the urinary protein/creatinine ratio (r ‫؍‬ ؊0.27, P < 0.05), and the 6-h BP amplitude was inversely correlated with proteinuria (r ‫؍‬ ؊0.3, P < 0.02). Children who displayed 24-or 12-h cardiovascular rhythms had significantly lower serum calcium levels than children without these rhythms. In summary, children with CRF display not only blunted circadian but also blunted ultradian cardiovascular rhythms. Ultradian but not circadian rhythms or conventional dipping parameters are quantitatively associated with renal function and proteinuria.

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Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients

Abstract: The non-dipping phenomenon is closely related to a high incidence of CV diseases, a poor long-term survival and profound autonomic dysfunction. ABPM is useful in predicting long-term CV prognosis in HD patients.

Cited by 209 publications

References 19 publications

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Small tumor size as favorable prognostic factor after adrenalectomy in Conn's adenoma

Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysis

Ultradian but not Circadian Blood Pressure Rhythms Correlate with Renal Dysfunction in Children with Chronic Renal Failure

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