Morning hypertension in chronic kidney disease is sustained type, but not surge type.
OBJECTIVE
We have shown that as renal function deteriorates, the circadian blood pressure (BP) rhythm shifts to a nondipper pattern and the duration until nocturnal BP decline [dipping time (DT)] is prolonged. We investigated whether or not morning hypertension (BP 2 h after awakening >135/85 mmHg) in chronic kidney disease (CKD) was sustained type with a prolonged DT.


METHODS
Twenty-four-hour BP was monitored in 104 patients with CKD. Fifty-one of 104 participants (group A) did not exhibit morning hypertension. The patients with morning hypertension (group B, n=53) were classified into three groups: group C (n=23), participants who exhibited morning hypertension but did not meet the criteria for the surge or sustained type; group D (n=29), the sustained type (with no night-time BP readings <120/70 mmHg); and group E (n=1), the surge type (systolic BP rises >25 mmHg after awakening).


RESULTS
The night/day BP ratio and DT were compared among groups A, C, and D because there was only one participant in group E. Night/day ratio of BP and DT were both significantly higher in group D compared with groups A and C. The prevalence of nondippers tended to be higher in group D compared with the other groups (A, 65%; C, 57%; D, 86%, P=0.09). Creatinine clearance was significantly lower in group D compared with groups A and C.


CONCLUSIONS
Sustained elevation of night-time BP until the early morning and high night/day ratio of BP may contribute to the high frequency of morning hypertension, which is generally the sustained rather than the surge type in CKD.
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Masashi
M
Mizuno
Michio
M
Fukuda
Toshiyuki
T
Miura
Tamaki
T
Wakamatsu
Takehiro
T
Naito
Ryo
R
Sato
Hiroyuki
H
Togawa
Yuji
Y
Sasakawa
Tatsuya
T
Tomonari
Minamo
M
Ono
Yoko
Y
Kato
Tadashi
T
Ichikawa
Yuichi
Y
Shirasawa
Akinori
A
Ito
Atsuhiro
A
Yoshida
Genjiro
G
Kimura
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002908:Chronic Disease; D002940:Circadian Rhythm / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D006973:Hypertension / Q000145:classification* / Q000503:physiopathology*; D007674:Kidney Diseases / Q000097:blood / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D055815:Young Adult
D003404:Creatinine