Nocturnal hypertension: Will control of nighttime blood pressure prevent progression of diabetic renal disease?
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Patients with type 1 and 2 diabetes and nephropathy frequently have a blunted fall in nighttime arterial blood pressure. This abnormality is already seen in subjects with type 1 diabetes who are in the microalbuminuric phase of the disease, and we have also shown that an increase in nighttime systolic blood pressure precedes the development of microalbuminuria. These studies suggest that nocturnal hypertension may be an important early predictor of diabetic nephropathy. Various drugs have different effects on nocturnal blood pressure, and chronotherapy may be key in determining clinical outcomes. There is a compelling need for studies showing that treating nocturnal hypertension in diabetes can prevent renal disease progression.
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References and Recommended Reading
- 9.Hany S, Baumgart P, Frielingsdorf J, et al.: Circadian blood pressure variability in secondary and essential hypertension. J Hypertens 1987, 5(Suppl):487–489S.Google Scholar
- 14.Schmitz A, Mau Pedersen M, Hansen KW: Blood pressure by 24 hours ambulatory recordings in type 2 (non-insulin dependent) diabetics: relationship to urinary albumin excretion. Diab Metab 1991, 17:301–307.Google Scholar
- 17.Lurbe A, Redon J, Pascual JM, et al.: Altered blood pressure during sleep in normotensive subjects with type I diabetes. Hypertension 1993, 21:227–235. One of the first cross-sectional studies finding that in type 1 diabetics with microalbuminuria, the physiologic nocturnal fall in blood pressure is blunted. It was postulated that it may prove to be a sensitive marker for renal disease and eventual progression to overt hypertension.PubMedGoogle Scholar
- 22.Poulsen PL, Hansen KW, Mogensen CE: Ambulatory blood pressure in the transition from normo- to microalbuminuria: a longitudinal study in IDDM patients. Diabetes 1994, 43:1248–1253. This study is a longitudinal follow-up of 44 initially normoalbuminuric type 1 diabetic patients that showed significant correlations between UAE and nocturnal hypertension.PubMedCrossRefGoogle Scholar
- 23.Lurbe E, Redon J, Kesani A, et al.: Increase in nocturnal blood pressure and progression to microalbuminuria in type 1 diabetes. N Engl J Med 2002, 347:797–805. The two key findings of this prospective study are: 1) In type 1 diabetics, an increase in systolic blood pressure during sleep precedes the development of microalbuminuria. 2) In those subjects whose blood pressure during sleep decreases normally, the progression from normal albumin excretion to microalbuminuria appears to be less likely.PubMedCrossRefGoogle Scholar
- 27.Equiluz-Bruck S, Schnack C, Kopp HP, Schernthaner G: Non-dipping of nocturnal blood pressure is related to urinary albumin excretion rate in patients with type 2 diabetes mellitus. Am J Hypertens 1996, 9:1139–1143. This study showed that non-dipping is related to UAE rates in type 2 diabetics and also a correlation of nocturnal blood pressure to UAE rates.PubMedCrossRefGoogle Scholar
- 33.Farmer CK, Goldsmith DJ, Quin JD, et al.: Progression of diabetic nephropathy: Is diurnal blood pressure rhythm as important as absolute blood pressure level? Nephrol Dial Transplant 1998, 13:635–639. This is a retrospective study of 26 type 1 and type 2 patients, with nephropathy showing that non-dippers had a more rapid rate of decline of creatinine clearance than dippers.PubMedCrossRefGoogle Scholar
- 41.Conte G, Rigon N, Perrone A: Application of chronotherapy to cardiovascular diseases. Rec Prog Med 1998, 89:465–469.Google Scholar
- 44.Hermida RC, Calvo C, Ayala DE, et al.: Administration timedependent effects of valsartan on ambulatory blood pressure in hypertensive subjects. Hypertension 2003, 42:283–290. A complete analysis of changes in blood pressure comparing nighttime versus daytime doses of valsartan, an angiotensin II blocker.PubMedCrossRefGoogle Scholar