Nephrology Dialysis Transplantation, Vol 12, Issue 11 2301-2307, Copyright © 1997 by Oxford University Press
C Farmer, D Goldsmith, J Cox, P Dallyn, J Kingswood and P Sharpstone
Background: Ambulatory blood pressure recordings have
been shown to correlate better with target organ damage than have isolated
clinic blood pressure readings. There have been some small studies
demonstrating that abnormal blood pressure diurnal rhythm is common in
uraemia and in patients on renal replacement therapy. Abnormal blood
pressure diurnal rhythm itself may be at risk factor for accelerated target
organ damage. Methods: We retrospectively studied 480
ambulatory blood pressure recordings in 380 patients with essential
hypertension, secondary hypertension, and on renal replacement therapy. We
examined diurnal blood pressure rhythm in each group.
Results: Abnormal blood pressure diurnal rhythm
(non-dipping) is significantly more prevalent in patients with underlying
renal disease, even with normal excretory renal function (53%) than in
age-, sex-, and race-matched controls with essential hypertension ((30%), P
<0.01). In patients with renal disease the prevalence of non-dipping
rose with worsening renal function, reaching statistical significance once
plasma creatinine was greater than 400 &mgr;mol/l. There was a direct
correlation between plasma creatinine and percent decline in blood pressure
at night for both systolic (r=0.23) and diastolic (r=0.24) blood pressure
in patients with underlying renal disease and impaired excretory renal
function. High prevalences of abnormal diurnal BP rhythm are seen in
patients on haemodialysis (82%), peritoneal dialysis (78%), patients with
plasma creatinine >600 &mgr;mol/l (75%), and in renal transplant
recipients (74%). Conclusion: Abnormal blood pressure
diurnal rhythm ('non-dipping') is significantly more common in secondary
than in primary hypertension, even with normal renal function. Abnormal
blood pressure diurnal rhythm becomes increasingly common with advancing
uraemia. Once the plasma creatinine is greater than 600 &mgr;mol/l the
prevalence of non-dipping is the same as that seen with renal replacement
therapy. This phenomenon is not modulated by successful renal
transplantation. Key words: ambulatory blood pressure;
dipper; antihypertensives; uraemia
ORIGINAL ARTICLES
An investigation of the effect of advancing uraemia, renal replacement therapy and renal transplantation on blood pressure diurnal variability
Trafford Department of Renal Medicine, Royal Sussex County Hospital, Brighton, East Sussex, UK; Corresponding author at: Royal Sussex County Hospital, Eastern Road, Brighton, East Sussex BN2 5BE, UK
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