Ambulatory blood pressure during diseases of the kidney

Blood Pressure Monitoring

Volumn 4, Issue 5, 1999, Pages 267-274

  Redon, Josep ^a   Oliver, Vicente ^a   Zaragoza, Maria Dolores ^a   Galindo, Maria Jose ^a  

^a UNIVERSITY OF VALENCIA   (Spain)

Author keywords

Ambulatory blood pressure; Chronic renal failure; Continuous ambulatory peritoneal dialysis; Diabetes; Hemodialysis; Hypertension; Kidney; Non dipper; Transplantation

Indexed keywords

ANTIHYPERTENSIVE AGENT;

BLOOD PRESSURE MONITORING; HEMODIALYSIS; HUMAN; KIDNEY DISEASE; KIDNEY FAILURE; KIDNEY POLYCYSTIC DISEASE; KIDNEY TRANSPLANTATION; PRIORITY JOURNAL; PROTEINURIA; RENOVASCULAR HYPERTENSION; REVIEW;

EID: 0033503240     PISSN: 13595237     EISSN: None     Source Type: Journal    
DOI: 10.1097/00126097-199900450-00010     Document Type: Review

References (65)

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22. 22 Giaconi S, Levanti C, Fommei E, Innocenti F, Seghieri G, Palla G, et al. Microalbuminuria and casual and ambulatory blood pressure monitoring in normotensives and in patients with borderline and mild essential hypertension. Am J Hypertens 1989; 2:259-261.
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24. 24 Redon J, Miralles A, Liao Y, Lozano JV, Pascual JM, Cooper RS. Circadian variability and microalbuminuria in essential hypertension. J Hypertens 1994; 12:947-954. The objective of the present study was to assess the relationship of subclinical UAE with ambulatory and circadian variability of blood pressure. One hundred and twenty-seven patients with essential hypertension (82 men and 59 women, mean age 38.9 ⊥ 7.3 years), who had never previously been treated for hypertension, were included in the study. Microalbuminuric patients (n = 31) had significantly higher moan ambulatory systolic and diastolic blood pressures than did those with normoalbuminuria (n = 96) during the 24 h, daytime (0800-2200 h) and night (0000-0600 h) periods, whereas for OBP only diastolic blood pressure was significantly higher, UAE was positively correlated to the means of systolic and diastolic blood pressures. Multiple regression analysis likewise confirmed that diastolic blood pressure during daytime was positively and day : night ratio of diastolic blood pressure inversely associated with UAE independently of age, sex and other parameters of ABP. The results indicate that the presence of microalbuminuria in middle-aged essential hypertensive patients is a marker for the presence of higher blood pressures throughout a 24 h period.
25. 25 Harsfield GA, Pullian DA, Alpert BS. Ambulatory blood pressure and renal function in healthy children and adolescents. Am J Hypertens 1994; 7:282-285.
26. 26 Hansen KW, Christensen CK, Andersen PH, Mau Pedersen M, Christiansen IS, Mogensen CE. Ambulatory blood pressure in microalbuminuric type 1 diabetic patients. Kidney Int 1992; 41:841-854.
27. 27 Moore WV, Donaldson DL, Chonko AM, Ideus P, Weidmann TB. Ambulatory blood pressure in type 1 diabetes mellitus. Comparison to presence of incipient nephropathy in adolescents and young adults. Diabetes 1992; 41.1035-1041.
28. 28 Benhamou PY, Halimi S, De Gaudemaris R, Boizel R, Pitiot M, Siche JP ef al. Early disturbances of ambulatory blood pressure load in normotensive type 1 diabetic patients with microalbuminuria. Diabetes Care 1992; 15:1614-1619.
29. 29 Lurbe A, Redon J, Pascual JM, Tacons J, Alvarez V, Batlle DC. Altered blood pressure during sleep in normotensive subjects with type I diabetes. Hypertension 1993; 21:227-235. By studying type 1 diabetics, defined as juvenile onset and the necessity for administration of insulin, the authors found that there was a blunted decline in the physiological nocturnal fall in blood pressure in normotensive microalbuminurics (n = 15) that normally occurs during sleep in comparison with those in normoalbuminurics (n = 30) and age-matched and sex-matched controls (n = 45). Day : night ratios of systolic and diastolic blood pressures in microalbuminurics were significantly lower than those observed for controls and normoalbuminurics. In this study the best relationship between ABP values and UAE was that obtained with nocturnal blood pressure.
30. 30 E Lurbe, J Redon, JM Pascual, J Tacons, V Alvarez, D Batlle. The spectrum of blood pressure abnormalities in type 1 diabetes [abstract]. J Am Soc Nephrol 1994; 5:380.
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33. 33 Mitchell TH, Nolan B, Henry M, Cronin C, Baker H, Greely G. Microalbuminuria in patients with non-insulin-dependent diabetes mellitus relates to nocturnal systolic blood pressure. Am J Med 1997; 102:531-535.
34. 34 Tovi J, Theobald H, Engfeldt P. Effect of metabolic control on 24-h ambulatory blood pressure in elderly non-insulin-dependent diabetic patients. J Hum Hypertens 1996; 10:589-594.
35. 35 Middeke M, Schrader J. Nocturnal blood pressure in normotensive subjects and those with white-coat, primary and secondary hypertension. BMJ 1994; 308:630-632.
36. 36 Imai Y, Abe K, Munakata M, Sakuma H, Hashimoto J, Imai K, et al. Does ambulatory blood pressure monitoring improve the diagnosis of secondary hypertension? J Hypertens 1990; 8 (suppl):S71-S75.
37. 37 Seeman T, Sikut M, Konrad M, Vondrichova H, Janda J, Scharer K. Blood pressure and renal function in autosomal dominant polycystic kidney disease. Pediatr Nephrol 1997; 11:592-596.
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40. 40 van der Borne, Tielemans Ch, Collart F, Vanherweghem JL, Degaute JP. Twenty-four-hour blood pressure and heart rate patterns in chronic hemodialysis patients. Am J Kidney Dis 1993; 22:419-425.
41. 41 Cottone S, Panepinto N, Vadala A, Zagarrigo C, Gallone P, Volpe V, et al. Sympathetic overactivity and 24 hour blood pressure pattern in hypertensives with chronic renal failure. Renal Failure 1995; 17:751-758.
42. 42 Jones MA, Kingswood JC, Dallyn PE, Andrew M, Cheetham A, Burwood R, et al. Changes in diurnal blood pressure variation and red cell and plasma volumes in patients with renal failure who develop erythropoietin induced hypertension. Clin Nephrol 1995; 44:193-200.
43. 43 Timio M, Venanzi S, Lolli S, Lippi G, Verdura C, Monarca C, et al. 'Non dipper' hypertensive patients and progressive renal insufficiency; a 3 year longitudinal study. Clin Nephrol 1995; 43:382-387. In this 3-year longitudinal case-control study the authors tested the hypothesis that there is an association between a lower than normal night-time fall in blood pressure or none at all and a future decline of kidney function for renal hypertensive patients. The cases were 48 hypertensives with renal insufficiency, divided into two groups according to the presence (dippers, n = 20) or absence (non-dippers, n = 28) of a nocturnal decline in diastolic blood pressure by greater than 10% of daytime values, detected by ABPM. In the baseline evaluation the two groups did not differ with respect to age, sex, body weight, office systolic and diastolic blood pressures, mean daytime ABP, rate of clearance of creatinine and 24 h proteinuria. In the ABP profiles over a 3-year follow-up the nocturnal reductions of systolic and diastolic blood pressures in the dippers were 14 and 15%, respectively, versus 7 and 5% in the non-dippers (P = 0.002/0.003). The non-dippers had a faster decline in rate of clearance of creatinine than did the dippers (0.37 ± 0.26 versus 0.27 ± 0.09 ml/min per month, P= 0.002). Increase in urinary protein excretion of protein for the non-dipper group was greater than that for the dipper group (993 ± 438 versus 691 ± 222 mg/24 h; P= 0.009). Results of this longitudinal study suggest that the non-dipping pattern of ABP is associated with a faster progression of renal insufficiency in renal hypertensives and that proper control of nocturnal blood pressure must be an additional aim of antihypertensive therapy.
44. 44 Farmer CK, Goldsmith DJ, Cox J, Dallyn P, Kingswood JC, Sharpstone P. An investigation of the effect of advancing uraemia, renal replacement therapy and renal transplantation on blood pressure diurnal variability. Nephrol Dial Transplant 1997; 12:2301-2307. The authors studied 480 ABP recordings of 380 patients with essential hypertension and secondary hypertension and undergoing kidney renal replacement. They examined diurnal rhythm of blood pressure for each group. Abnormal diurnal rhythms of blood pressure (non-dipping) were significantly more prevalent among patients with underlying renal disease, even with normal excretory renal function (53%) than they were among controls with essential hypertension matched for age, sex and race (30%). For patients with renal disease the prevalence of non-dipping rose with worsening renal function. This relationship attained statistical significance once plasma level of creatinine was greater than 400 μmol/l. There were direct correlations between plasma level of creatinine and percentage decline in blood pressure at night both for systolic (r = 0.23) and for diastolic (r=0.24) blood pressure in patients with underlying renal disease and impairment of renal excretory function. High prevalences of abnormal diurnal rhythms of blood pressure are seen among patients undergoing haemodialysis (82%) and peritoneal dialysis (78%), patients with plasma levels of creatinine > 600 μmol/l (75%) and recipients of kidney transplants (74%). Abnormal diurnal rhythm of blood pressure becomes increasingly common with advancing uraemia. Once the plasma level of creatinine was greater than 600 μmol/l the prevalence of non-dipping was the same as that among cases of kidney replacement. This phenomenon was not modulated by successful kidney transplantation.
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48. 48 Dionisio P, Valenti M, Bergia R, Caramello E, Stramignoni E, Berto IM, et al. Influence of the hydration state on blood pressure values in a group of patients on regular maintenance hemodialysis. Blood Purif 1997; 15:25-33.
49. 49 Lins RL, Elseviers M, Rogiers P, Van Hoeyweghen RJ, De Raedt H, Zachee P, et al. Importance of volume factors in dialysis related hypertension. Clin Nephrol 1997; 48:29-33. The objective was to evaluate the relation between total body water and dialysis-related hypertension. Thirty stable chronic haemodialysis patients were studied. Twenty-four-hour ABP on the day before dialysis, blood pressures before and after dialysis, gain in weight, ultrafiltration and total body water were determined. Total body water was measured by body impedance analysis and expressed as percentage of dry weight (PTBW). Patients, classified as normotensive (n = 11) or hypertensive (n = 19), on the basis of 24 h blood pressure measurements, had significantly different PTBW (54.7 ± 5.3 versus 58.9 ± 4.6%, P= 0.046). Ambulatory blood pressure and postdialysis blood pressure, but not predialysis blood pressure, were significantly correlated to PTBW. Acute changes in volume, reflected by interdialytic gain in weight and ultrafiltration, were not correlated to PTBW, These changes wore correlated weakly to predialysis blood pressure. Multivariate analysis showed that only PTBW and antihypertensive medication had independent influences on 24 h blood pressure. The authors concluded that 24 h blood pressure and blood pressure after dialysis are better related to total body water than is blood pressure before dialysis, which was, however, weakly related to the acute volume overload induced by interdialytic gain in weight.
50. 50 Goldsmith DJ, Covic AC, Venning MC, Ackrill P. Ambulatory blood pressure monitoring in renal dialysis and transplant patients. Am J Kidney Dis 1997; 29:593-600. One hundred and seventeen patients (60 undergoing haemodialysis, 29 with CAPD and 28 recipients of transplants) underwent ABPM, The parathormone level was the major determinant of ABP; Interdialytic gain in weight and age had weaker associations.
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