title: Abnormalities in chronic kidney disease of ambulatory blood pressure 24 h patterning and normalization by bedtime hypertension chronotherapy.
abstract: In chronic kidney disease (CKD), the prevalence of hypertension is very high, escalating with diminishing renal function. Typically, the diagnosis of hypertension and the clinical decisions regarding its treatment are based on daytime clinic blood pressure (BP) measurements. However, the correlation between BP level and target organ damage, cardiovascular risk and long-term prognosis is greater for ambulatory than clinic measurements. Moreover, evidence is consistent among numerous studies that the elevated risk and incidence of end-organ injury and fatal and non-fatal cardiovascular events are significantly associated with blunted night-time BP decline, and that the asleep BP better predicts cardiovascular events than either the awake or 24-h BP mean. The prevalence of abnormally high asleep BP is extensive in CKD, significantly increasing with its severity. In CKD, the diagnoses of hypertension and its therapeutic control are often inaccurate in the absence of complete and careful assessment of the entire 24 h, i.e. daytime and night-time, BP pattern. Accordingly, ambulatory BP monitoring should be the preferred method to comprehensively assess and decide the optimal clinical management of patients with CKD. Recent findings indicate therapeutic restoration of normal physiologic BP reduction during night-time sleep is the most significant independent predictor of decreased cardiovascular and cerebrovascular risk, both in patients with and without CKD, and is best achieved when antihypertensive medications, mainly those blocking the renin-angiotensin-aldosterone system, are routinely taken at bedtime.
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain.
authors.forename: Ramón C
authors.initials: RC
authors.lastname: Hermida
authors.affiliation: Cockrell School of Engineering, Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Smolensky
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Ayala
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain.
authors.forename: José R
authors.initials: JR
authors.lastname: Fernández
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain Centro de Salud de Lérez, Gerencia Única Integrada Pontevedra-Salnés, Servicio Galego de Saúde (SERGAS), Pontevedra, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Moyá
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain Centro de Salud de Bembrive, Estructura de Gestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Crespo
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain.
authors.forename: Artemio
authors.initials: A
authors.lastname: Mojón
authors.affiliation: Bioengineering & Chronobiology Laboratories, University of Vigo, Campus Universitario, Vigo, Spain Centro de Salud de A Doblada, Estructura de Gestión Integrada de Vigo, Servicio Galego de Saúde (SERGAS), Vigo, Spain.
authors.forename: María T
authors.initials: MT
authors.lastname: Ríos
authors.affiliation: Hypertension Center, University Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Fabbian
authors.affiliation: Hypertension Center, University Hospital S. Anna and Department of Medical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Portaluppi
mesh_terms: D000328:Adult; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000150:complications; D019454:Chronotherapy; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology*; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D012890:Sleep / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents
keywords: ambulatory blood pressure monitoring; asleep blood pressure; cardiovascular risk; chronic kidney disease; chronotherapy