Morning Blood Pressure Predicts Hypertensive Organ Damage in Patients with Renal Diseases: Effect of Intensive Antihypertensive Therapy in Patients with Diabetic Nephropathy

• KURIYAMA Satoru

  Division of Nephrology, Saiseikai Central Hospital, Tokyo

• OTSUKA Yasushi

  Division of Nephrology, Saiseikai Central Hospital, Tokyo

• IIDA Rinako

  Division of Nephrology, Saiseikai Central Hospital, Tokyo

• MATSUMOTO Kei

  Division of Nephrology, Saiseikai Central Hospital, Tokyo

• TOKUDOME Goro

  Department of Kidney & Hypertension, Jikei University School of Medicine, Tokyo

• HOSOYA Tatsuo

  Department of Kidney & Hypertension, Jikei University School of Medicine, Tokyo

抄録

Blood pressure (BP) measured at home early in the morning (HBP) has been recognized as a useful predictor for organ damage and has been viewed as an important therapeutic target in patients with hypertension. The present study was aimed to determine whether this notion holds true in patients with progressive renal disease.<br>The study enrolled patients with mild to moderate renal impairment. They were all directed to record self-measured HBP to evaluate the adequacy of BP control. In addition to the conventional antihypertensive therapy, intensive treatment to more efficiently reduce elevated morning HBP was applied, especially in patients with diabetic nephropathy. The results were as follows:<br>1) The status of BP control assessed using HBP and office/clinic BP (OBP) shows predominance of morning hypertension. The prevalence of patients with well-controlled systolic HBP was 38%, those with poorly-controlled HBP 30%, masked hypertension 20% and white coat hypertension 12%.<br>2)Early morning systolic HBP in diabetics was significantly higher than that in non-diabetics. However, when evaluated on systolic OBP, both groups were comparable.<br>3)Logistic regression analysis showed that the predictive variables to explain morning hypertension (more than 130 mmHg and increased systolic HBP) were age, amount of daily urinary protein excretion and left ventricular mass index (LVMI).<br>4)Following conventional therapy, intensive antihypertensive therapy consisting of calcium channel blockers (CCB) and/or diuretics given in the morning, and angiotensin receptor blockers (ARB) given in the evening, together with α1-blockers given at bedtime, efficaciously reduced elevated HBP in the morning. This result was associated with significant reduction in daily urinary protein excretion and in serum plasminogen-activator inhibitor (PAI-1) concentration.<br>The present study indicates that, regardless of ongoing conventional antihypertensive therapy, the majority of patients with renal disease had morning hypertension, suggesting that these patients are at a higher risk for cardiovascular disease. For the purpose of improving morning hypertension, intensive treatments with combined CCB, ARB and α1-blockers could have substantial benefit on the morbidity and prognosis in patients with diabetic nephropathy.

収録刊行物

• Internal Medicine

  Internal Medicine 44 (12), 1239-1246, 2005

  一般社団法人 日本内科学会

キーワード

• morning blood pressure
• home blood pressure
• diabetic nephropathy
• antihypertensive agents
• proteinuria
• left ventricular mass index

詳細情報

• CRID: 1390001204867781504
• NII論文ID: 10016917411
• NII書誌ID: AA10827774
• DOI: 10.2169/internalmedicine.44.1239
• ISSN: 13497235
• ISSN: 09182918
• NDL書誌ID: 7753945
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I7753945
• Web Site: http://www.jstage.jst.go.jp/article/internalmedicine/44/12/44_12_1239/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2006248465
• 本文言語コード: en
• データソース種別:
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