The impact of non-dipper circadian rhythm of blood pressure on left ventricular hypertrophy in patients with non-dialysis chronic kidney disease

Abstract

Objective The aim of this study was to investigate the correlation between non-dipper circadian rhythm of blood pressure (BP) and left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD). Methods and results All 257 patients with stage 1 to 5 CKD were enrolled in the study and classified into a CKD1-3 group and a CKD4-5 group according to renal function. The parameters and circadian rhythm of BP were measured by a GE Marquette Tonoport V Eng dynamic sphygmomanometer, and cardiac structure was examined by echocardiography. The incidence of abnormal circadian BP rhythm (non-dipper rhythm) was quite high (75.4% in all enrolled patients and 71.3% in the patients with normal BP levels) in CKD patients and increased with the deterioration of renal function. Changes of cardiac structure such as LVH in patients with non-dipper BP were more distinct than in patients with dipper BP. The development of left ventricular mass index (LVMI) correlated positively with the incidence of non-dipper BP rhythm. Multiple regression analysis showed that 24-h systolic BP (β = 0.417, P < 0.01), triglycerides (TG) (β = -0.132, P = 0.007), Hb (β = -0.394, P = 0.016) and gender (β = 0.158, P = 0.039) were independent risk factors of LVMI. Conclusions The incidence of non-dipper circadian rhythm of blood pressure was quite high in CKD patients and increased with the deterioration of renal function. Non-dipper circadian rhythm of BP is closely related with LVMI.

Суточный Профиль Артериального Давления У Детей С Хроническим Пиелонефритом И Хронической Болезнью Почек I–III Стадии

“…Taking into consideration that non-dipping BP pattern is associated with suppression of parasympathetic nervous system activity and an increase in sympathetic nervous system activity throughout the night, it appears that hypersympathicotonia significantly influence not only 24-hour BP profile and AH development, but also CKD progression [20]. In the view of most clinicians, the non-dipping circadian rhythm of BP in CKD patients is closely linked to cardiovascular complications, particularly, left ventricular hypertrophy [21].…”

The Effects of Eplerenone on the Circadian Blood Pressure Pattern and Left Ventricular Hypertrophy in Patients with Obstructive Sleep Apnea and Resistant Hypertension—A Randomized, Controlled Trial

“…As demonstrated in the Syst-Eur study, higher incidence of stroke and myocardial infraction was revealed in non-dipper patients [35]. In patients with circadian BP profile disorders such complications like LVH, microalbuminuria, thickening of the intima media in the carotid artery and neurological incidents are significantly more common [36,37,38]. Finding of increased incidence of concentric hypertrophy (CH) may partially explain the higher incidence of cardiovascular events in these patients.…”

Correlations of Circadian Rhythm Disorder of Blood Pressure with Arrhythmia and Target Organ Damage in Hypertensive Patients

“…Sympathetic nervous activity in the human body is the weakest at night when the muscles are relaxed sufficiently, and peripheral vascular resistance is also minimized, and during this period blood pressure is a good indicator of the degree of disease [16]. The results of the present research showed that the circadian rhythm disorder group had remarkably higher d-SBP, d-DBP, and d-PP but lower n-SBP, n-DBP, and n-PP than in the normal circadian rhythm group, which may be related to the strengthened stress-sensitivity of sympathetic nervous system activity and decreased function of vagus nerve in patients with circadian rhythm disorder of blood pressure, suggesting that such patients have severe hypertension.…”