Reversed Circadian Blood Pressure Rhythm Independently Predicts Endstage Renal Failure in Non–Insulin-Dependent Diabetes Mellitus Subjects

Nakano, Shigeru; Ogihara, Mari H.; Tamura, Chinami; Kitazawa, Mitsutaka; Nishizawa, Makoto; Kigoshi, Toshikazu; Uchida, Keiji

doi:10.1016/s1056-8727(99)00049-5

Cited by 33 publications

(18 citation statements)

References 24 publications

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“…In the present study, we confirmed nighttime SBP predicted endstage renal failure (Nakano, Ogihara, Tamura, Kitazawa, Nishizawa, Kigoshi and Uchida, 1999). As nighttime SBP is associated with degree of albuminuria (Mitchell et al, 1997;Leittao, Molon, Canani, Pinotti, Polson and 12 24hBPtyp2JDC_rev.doc/ BT09mimatyp2.sav/biopsy.ref 120522 Gross, 2005) and inversely with glomerular filtration rate (Torffvit, Tapia, Rippe, Alm, Willner and Tencer, 2004) it may be possible to directly measure the effect of treatment on nighttime SBP by evaluating the effect on albuminuria/GFR.…”

Section: Discussionsupporting

confidence: 73%

“…Ambulatory blood pressure measuring (ABPM) showed increased nighttime systolic BP to be associated with increased albuminuria (Mitchell, Nolan, Henry, Cronin, Baker, Greely and Oreland, 1997), decreased glomerular filtration rate (Torffvit, Tapia, Rippe, Alm, Willner and Tencer, 2004), development of endstage renal failure (Nakano, Ogihara, Tamura, Kitazawa, Nishizawa, Kigoshi and Uchida, 1999) and death (Palmas, Pickering, Teresi, Schwartz, Moran, Weinstock and Shea, 2009). …”

Section: Introductionmentioning

confidence: 99%

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The effect of achieving a systolic blood pressure of 140mmHg. A prospective study of ambulatory measurements in type 2 diabetic patients with nephropathy

Torffvit

2012

Journal of Diabetes and its Complications

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The effect of achieving a systolic blood pressure of 140 mmHg. A prospective study of ambulatory measurements in type 2 diabetic patients with nephropathy Torffvit, Ole General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Subjects. 118 type 2 diabetic patients with micro-macroalbuminuria were followed for four years (range 1-8 years).Method and main outcome measures. The prognostic significance of office, day-and nighttime measurements of blood pressure (BP) for development of cardiovascular complications was studied.Results. Forty-two percent (n=49) developed one or more of the following cardiovascular endpoints: 23% (n=27) death, 9% (n=10) stroke, 9% (n=11) myocardial infarction, 9% (n=11) heart failure, 31% (n=36) uremia and 17% (n=20) need for dialysis. Reaching the goal for day-and nighttime systolic BP (SBP) at baseline of <140 mmHg was associated with lower risk for developing uremia. Reaching the goal for nighttime SBP was associated with a decreased risk for developing myocardial infarction and need for dialysis treatment. None of these associations was found for office SBP.Patients not achieving the goal for nighttime systolic blood pressure of <140 mmHg had a 12.9 times higher risk of developing myocardial infarction and 3.9 times increased risk of uremia and 2.7 times increased risk for death than patients achieving the goal.Conclusion. Nighttime blood pressure had better prognostic significance for developing cardiovascular and renal complications than office and daytime blood pressure. Abbreviations. ABPM = ambulatory blood pressure measurements. BP = blood pressure. SBP = systolic blood pressure. DBP = diastolic blood pressure. GFR = glomerular filtration rate.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

The effect of achieving a systolic blood pressure of 140mmHg. A prospective study of ambulatory measurements in type 2 diabetic patients with nephropathy

Torffvit

2012

Journal of Diabetes and its Complications

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“…Our findings were also compatible with the proposal that as the number of nephrons is reduced BP becomes more sodium sensitive (4, 23− 25). On the other hand, the non-dipper type of circadian BP rhythm is often considered to be a risk factor for the progression of nephropathy (10,13,14). However, since the degree of non-dipping was closely correlated with the degree of loss of renal function, as discussed above, non-dipping might be correlated with the progression of nephropathy.…”

Section: Discussionmentioning

confidence: 99%

“…In consideration of this finding, together with the well known facts that in patients with renal dysfunction the nocturnal BP fall is lost (6−10) and is restored from non-dipper to dipper patterns after kidney transplantation (11) and by sodium restriction and diuretics (2,3,12), circadian rhythm of BP is likely to be determined at least in part by the kidneys. On the other hand, the non-dipper type of circadian BP rhythm is often considered to be a risk factor for the progression of nephropathy (10,13,14). In particular, an increase in systolic BP (SBP) during sleep has been reported to precede the development of microalbuminuria in persons with type 1 diabetes (13).…”

Section: Introductionmentioning

confidence: 99%

Circadian Blood Pressure Rhythm Is Disturbed by Nephrectomy

et al. 2005

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We recently illustrated a close relationship between glomerular filtration rate and circadian rhythm of blood pressure (BP) in patients with chronic kidney disease. However, it remains undetermined from such crosssectional findings which occurs first, the loss of kidney function or the lack of nocturnal BP fall. In the present study, we examined whether circadian rhythm of BP is affected by unilateral nephrectomy for kidney donation to clarify this important issue. Fifteen healthy subjects (4 men, 11 women; aged 33 to 65 years; mean age 55 ± 2 years) who underwent unilateral nephrectomy for kidney donation were studied. Ambulatory

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“…7,35,45,46 Alternatively, the non-dipper pattern of circadian BP rhythm is often considered to be a risk factor for the progression of nephropathy. [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.…”

Section: Salt Sensitivity and Circadian Rhythm Of Blood Pressurementioning

confidence: 99%

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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Reversed Circadian Blood Pressure Rhythm Independently Predicts Endstage Renal Failure in Non–Insulin-Dependent Diabetes Mellitus Subjects

Cited by 33 publications

References 24 publications

The effect of achieving a systolic blood pressure of 140mmHg. A prospective study of ambulatory measurements in type 2 diabetic patients with nephropathy

The effect of achieving a systolic blood pressure of 140mmHg. A prospective study of ambulatory measurements in type 2 diabetic patients with nephropathy

Circadian Blood Pressure Rhythm Is Disturbed by Nephrectomy

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

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