The circadian blood pressure rhythm in non-diabetic hemodialysis patients

I. Narita et al., The circadian blood pressure rhythm in non-diabetic hemodialysis patients, HYPERTENS R, 24(2), 2001, pp. 111-117
Citations number
Categorie Soggetti
Cardiovascular & Respiratory Systems
Journal title
Hypertension research
ISSN journal
0916-9636 → ACNP
Year of publication
111 - 117
SICI code
This study investigates the circadian blood pressure variation of non diabe tic chronic hemodialysis (HD) patients on both HD and non-HD days as well a s the factors affecting diurnal BP variation. Forty-nine HD patients aged 6 1.8+/-12.9 years who were on daytime HD for 97+/-68 months were studied. No significant difference was found in every daytime and nighttime BP between the first (HD) and the second (non-HD) day. However, the ratio nighttime/d aytime BP was significantly higher on the second day. Each BP diurnal varia bility pattern was classified as either Dipper (D: the ratio nighttime/dayt ime mean BP 0.8-0.9), nondipper (0.9< ND<1.0), or inverted dipper (ID>1.0). More than 75% of the cases were classified as ND (26 cases) or ID (11 case s). The ultrafiltration rate in D was significantly less than that in ND an d ID. The difference of plasma renin activity between pre- and post-HD (dRe n) was significantly higher in ID than in D and ND. The amount of dialysis (Kt/V) was found to be significantly correlated with nighttime BP fall. Ult rafiltration, dRen and KW were independent factors for the abnormal BP diur nal variability. In conclusion, the decreased nocturnal BP fall seen in non -diabetic HD patients is associated with increased extracellular fluid even in the patients without overt overhydration, whereas relatively insufficie nt amount of dialysis (low Kt/V) may be another possible cause. The increas ed dRen observed only in ID patients may reflect occult cardiovascular dama ge or functional disturbances in aortic and carotid baroreflexes caused by arterial structural changes.