Bp And Renal

24 hr BP control Renal aspects

Hypertension and Chronic Renal Disease: Hemodynamic Abnormalities Mean BP Total Systemic Vascular Resistance = X ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Increased Vasoconstriction  Adrenergic Stimuli  Angiotensin II  Endothelin  Endothelium-derived Contracting Factors  Thromboxane Cardiac Output Decreased Vasodilation  Prostacyclin  Nitric oxide  EDHF* Textor SC. Atlas of Diseases of the Kidney, 2001. *Endothelium-derived Hyperpolarizing Factors www.hypertensiononline.org

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],DIURNAL BLOOD PRESSURE VARIATION IS LONG RECOGNISED !

Diurnal blood pressure variation Am J Hypertens 2005; 18: 149-151.

Altered Circadian rhythm in CKD Nephrol Dial Transplant (1997) 12: 2301–2307

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Arch Intern Med. 2006;166:846-852

Dippers vs Non dippers - only significantly different parameters shown - values in brackets are percentage of total Arch Intern Med. 2006;166:846-852 ACEI, BB Antihypertensive drugs 47 (25.4) 17 (12.4) Coronary artery disease 162 (87.6) 92 (67.2) Hypertension 32 (17.3) 9 (6.6) Diabetes mellitus 65.7 ± 12.2 61.3 ± 12.6 Age, y Non dippers (n = 185) Dippers (n = 137) Variable

Dippers vs Non dippers - only significantly different parameters shown - values in brackets are percentage of total Arch Intern Med. 2006;166:846-852 49.5 ± 15.2 55.8 ± 17.3 High-density lipoprotein 163.8 ± 93.7 129.4 ± 68.9 Triglyceride level, mg/dL 64.7 ± 26.6 81.0 ± 20.7 GFR at Follow-up 102.4 ± 28.5 95.7 ± 19.2 FBG, mg/dL Non dippers (n = 185) Dippers (n = 137) Variable

Dippers vs Non dippers Arch Intern Med. 2006;166:846-852

Non Dipping pattern – Cause or effect ? ,[object Object],Hypertens Res 2005; 28: 301–306 Results suggest that unilateral nephrectomy disturbs the circadian rhythm of BP as a function of renal dysfunction without affecting absolute levels of BP Non dipping of BP seems to be the consequence of the loss of renal function, rather than the cause

Am J Physiol Renal Physiol 2007 293:655-659

ABPM findings in a community ,[object Object],[object Object],[object Object],Journal of Hypertension 2007, 25:977–984

ABPM findings in a community Journal of Hypertension 2007, 25:977–984

Nocturnal BP Changes and CV Mortality: Ohasama study Extreme dippers Dippers Non-dippers Risers Risk of CV Mortality Ohkubo et al; AJH 1997; 10: 1201

Analysis of The Influence of the Morning Surge of BP on Stroke Incidence Cox regression analysis for clinical stroke events Covariates RR P value Age (10 yrs) 1.80 (1.21-2.69) 0.004 Male gender 1.42 (0.76-2.67) 0.266 BMI 0.98 (0.90-1.07) 0.663 24 hr SBP 1.37 (1.16-1.63) 0.003 Morning BP surge* 1.29 (1.10-1.51) 0.001 Nocturnal BP fall* 0.88 (0.73-1.06) 0.167 Lowest sleep BP 1.05 (0.65-1.71) 0.837 * per 10 mmHg Kario, Pickering et al, Circ 2003; 107:1401

Cause of Circadian Rhythms - Role of the Autonomic system ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypertension 2000;35;892-897

Role of the Autonomic system ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hypertension 2000;35;892-897

How to tackle the variations Pharmacodynamic Pharmacokinetic maintain blood concentration of a drug for longer periods longer acting drugs ,[object Object],[object Object]

Diuretics Convert Non-Dippers to Dippers Systolic pressure mmHg Day Night No Rx HCTZ No Rx HCTZ Dippers Non-Dippers Uzu & Kimura Circ 1999; 100:1635

Effects of Alpha-Blockade on the Morning Surge of Blood Pressure Kario, Pickering, et al Am J Hypertens 2004;17; 668 Doxazosin No Rx

Role of alpha blockers ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Clinical and Experimental Hypertension, 2005; 27:129 - 138

Pre Tx(n = 30) – CCB/DU + ARB Tx (n = 27) – Pre Tx + AB at bedtime

Changing the timing of dosing helps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AJKD, 2007;50(6):908-17

Changing the timing of dosing helps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],AJKD, 2007;50(6):908-17

Question: If you were allowed just one reading over 24 hours to predict morbidity, which would you choose? Gosse et al, J Hum Hypertens 2001; 15: 413 Awake Awake Sleep Going to bed Arising Evening BP Lowest BP Preawake BP Morning BP

[object Object],[object Object],[object Object],[object Object],[object Object],Curr Opin Nephrol Hypertens, 2006 15:309–313

Bp And Renal

Recomendados

Recomendados

Mais conteúdo relacionado

Mais procurados

Mais procurados (20)

Destaque

Destaque (6)

Semelhante a Bp And Renal

Semelhante a Bp And Renal (20)

Último

Último (20)

Bp And Renal