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Yan P, Tang Q, Wu Y, Wan Q, Zhang Z, Xu Y, Zhu J, Miao Y. Serum albumin was negatively associated with diabetic peripheral neuropathy in Chinese population: a cross-sectional study. Diabetol Metab Syndr 2021; 13:100. [PMID: 34526116 PMCID: PMC8444578 DOI: 10.1186/s13098-021-00718-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 09/01/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies that explored the relationship of serum albumin with diabetic peripheral neuropathy (DPN) have indicated inconsistent results. Thus, the present study aimed to evaluated the association between serum albumin and DPN, defined as vibration perception threshold (VPT) values ≥ 25 V and/or inability to feel the monofilament, in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS 1465 T2DM patients aged ≥ 16 years, who completed the measurement of serum albumin and DPN screening between 2012 and 2015, were included in the cross-sectional study. Correlation and multivariate logistic regression analysis models were used to evaluate the possible relationship between serum albumin and DPN. RESULTS Patients with higher quartiles of serum albumin had significantly lower VPT values and prevalence of DPN compared with those with lower quartiles (P for trend < 0.01), and there was an inverse relationship between serum albumin and VPT values and prevalence of DPN (all P < 0.01). Multivariate logistic regression analysis demonstrated that the risk of DPN was progressively decreased across serum albumin quartiles (P for trend < 0.01), and participants in the highest quartile of serum albumin were at a significantly decreased risk of DPN compared to those in the lowest quartile (odds rate: 0.311, 95% confidence intervals 0.134-0.724, P < 0.01). ROC analysis revealed that the optimal cutoff point of serum albumin for the prevalence of DPN was 39.95 g/L in patients with T2DM, with a sensitivity of 65.88% and a specificity of 66.7%. CONCLUSIONS Decreased levels of serum albumin might be correlated with increased risk of DPN in Chinese patients with T2DM. Future longitudinal studies with large samples are warranted to confirm our findings, and elucidate putative mechanisms for the association.
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Affiliation(s)
- Pijun Yan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China.
| | - Qian Tang
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yuru Wu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Qin Wan
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Zhihong Zhang
- Department of General Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Yong Xu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Jianhua Zhu
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
| | - Ying Miao
- Department of Endocrinology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, Sichuan, China
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2
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Wen RW, Chen XQ, Zhu Y, Ke JT, Du Y, Wang C, Lou TQ. Ambulatory blood pressure is better associated with target organ damage than clinic blood pressure in patients with primary glomerular disease. BMC Nephrol 2020; 21:541. [PMID: 33308181 PMCID: PMC7731761 DOI: 10.1186/s12882-020-02200-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 12/02/2020] [Indexed: 12/14/2022] Open
Abstract
Background Blood pressure is an important and modifiable cardiovascular risk factor. Ambulatory blood pressure monitoring (ABPM) provides valuable prognostic information in patients with chronic kidney disease (CKD), yet little is known about the association of various types of BP measurements with target organ damage (TOD) in patients with primary glomerular disease. The goal of this study was to investigate whether ambulatory blood pressure is better associated with TOD than clinic blood pressure in patients with primary glomerular disease. Methods 1178 patients with primary glomerular disease were recruited in this cross-sectional study. TOD were assessed by the following 4 parameters: left ventricular mass index (LVMI or LVH, left ventricular hypertrophy), estimated glomerular filtration rate (eGFR< 60 ml/min/1.73m2), albumin-to-creatinine ratio (ACR ≥ 30 mg/g) and carotid intima-media thickness (cIMT) or plaque. Receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to evaluate the relationship between ambulatory or clinic systolic blood pressure (SBP) indexes and TOD. Results Among 1178 patients (mean age, 39 years,54% men), 116, 458, 1031 and 251 patients had LVH, eGFR < 60 ml/min/1.73m2, ACR ≥ 30 mg/g and cIMT≥0.9 mm or plaque respectively. Area under ROC curves for TOD in ambulatory SBP, especially nighttime SBP, was greater than that in clinic SBP (P < 0.05). Multivariate logistic regression analyses showed that 24 h SBP, daytime SBP and nighttime SBP were significantly associated with LVH, eGFR< 60 ml/min/1.73m2 and ACR ≥ 30 mg/g after adjustment for clinic SBP, while the association of clinic SBP was attenuated after further adjustment for nighttime SBP. Conclusions Ambulatory blood pressure, especially nighttime blood pressure, is probably superior to clinic blood pressure and has a significant association with TOD in primary glomerular disease patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02200-1.
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Affiliation(s)
- Ruo-Wei Wen
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Xiao-Qiu Chen
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Ye Zhu
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Jian-Ting Ke
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Yi Du
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China.,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, the Fifth affiliated hospital Sun Yat-Sen University, ZhuHai, 519000, Guangdong, China. .,Guangdong Provincial Key Laboratory of Biomedical Imaging, the Fifth affiliated hospital Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
| | - Tan-Qi Lou
- Division of Nephrology, Department of Medicine, the Third affiliated hospital Sun Yat-Sen University, GuangZhou, 510000, Guangdong, China
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3
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Tamura K, Waki K, Kawai Y, Ueda E, Ishii T, Wakui H. Possible interesting link between dipping status and morning surge for subclinical target organ damage in hypertension. J Clin Hypertens (Greenwich) 2019; 21:1295-1297. [PMID: 31376242 DOI: 10.1111/jch.13637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Kayo Waki
- Department of Ubiquitous Health Informatics, Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuki Kawai
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Eiko Ueda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Takeo Ishii
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiromichi Wakui
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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4
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Kado H, Kusaba T, Matoba S, Hatta T, Tamagaki K. Normotensive non-dipping blood pressure profile does not predict the risk of chronic kidney disease progression. Hypertens Res 2018; 42:354-361. [PMID: 30546105 DOI: 10.1038/s41440-018-0155-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 02/04/2023]
Abstract
The lack of a decrease in nocturnal blood pressure is a risk factor for the progression of chronic kidney disease (CKD); however, it currently remains unknown whether it is a risk factor in normotensive CKD patients. We conducted a retrospective cohort study and enrolled 676 CKD patients who underwent ambulatory blood pressure monitoring (ABPM). According to their nocturnal blood pressure dipping pattern (>10%: dipper or <10%: non-dipper) and average 24-h systolic blood pressure (>130/80 mmHg: hypertension or <130/80 mmHg: normotension), patients were divided into four groups. The estimated glomerular filtration rate (eGFR) decline over 2 years and relevant clinical parameters were analyzed among groups. Among all participants, 82.7% were non-dippers and half of them were normotensive. The eGFR decline was the most rapid in hypertensive non-dipper patients (4.73 ± 0.45 ml/min/1.73 m2/2 years), and was not significantly different between normotensive non-dipper (1.31 ± 0.49 ml/min/1.73 m2/2 years) and dipper patients (1.69 ± 0.80 ml/min/1.73 m2/2 years). A multivariate regression analysis revealed that the amount of urinary protein (95% confidence interval (CI): 1.51-2.63), 24-h systolic blood pressure (95% CI 1.13-1.45), and eGFR (95% CI 1.02-1.44) were associated with a rapid eGFR decline. We conclude that, according to the ABPM-based analysis, a non-dipping blood pressure pattern in normotensive CKD patients does not predict the risk of a rapid decline in eGFR. This suggests that the control of blood pressure, rather than its circadian rhythm, is essential for the preservation of eGFR.
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Affiliation(s)
- Hiroshi Kado
- Department of Nephrology, Omihachiman Community Medical Center, Shiga, Japan.,Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuro Kusaba
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tsuguru Hatta
- Department of Nephrology, Omihachiman Community Medical Center, Shiga, Japan
| | - Keiichi Tamagaki
- Department of Nephrology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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5
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Kobayashi R, Tamura K, Wakui H, Ohsawa M, Azushima K, Haku S, Uneda K, Ohki K, Haruhara K, Kinguchi S, Umemura S. Effect of single-pill irbesartan/amlodipine combination-based therapy on clinic and home blood pressure profiles in hypertension with chronic kidney diseases. Clin Exp Hypertens 2016; 38:744-750. [PMID: 27936999 DOI: 10.1080/10641963.2016.1200063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
We examined the efficacy of single-pill irbesartan/amlodipine combination-based therapy for 12 weeks in 20 hypertensive chronic kidney disease (CKD) patients, by evaluating self-measured home blood pressure (BP) profile. The single-pill irbesartan/amlodipine combination-based therapy decreased clinic BP and home BP (morning, evening, and nighttime BPs), and improved within-visit clinic BP variability, day-by-day home BP variability (morning and evening), and nighttime home BP variability. Furthermore, the single-pill combination-based therapy reduced albuminuria and exerted improved parameters of vascular function. These results indicate that this single-pill combination-based therapy may exert beneficial effects on clinic and home BP profiles as well as on renal and vascular damages, in hypertension with CKD.
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Affiliation(s)
- Ryu Kobayashi
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kouichi Tamura
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Hiromichi Wakui
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Masato Ohsawa
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kengo Azushima
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Sona Haku
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kazushi Uneda
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kohji Ohki
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Kotaro Haruhara
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Sho Kinguchi
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Satoshi Umemura
- a Department of Medical Science and Cardiorenal Medicine , Yokohama City University Graduate School of Medicine , Yokohama , Japan
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Tamura K, Wakui H, Azushima K, Uneda K, Umemura S. Circadian blood pressure rhythm as a possible key target of SGLT2 inhibitors used for the treatment of Type 2 diabetes. Hypertens Res 2016; 39:396-8. [DOI: 10.1038/hr.2016.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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7
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Wang C, Zhang J, Deng W, Gong W, Liu X, Ye Z, Peng H, Lou T. Nighttime Systolic Blood-Pressure Load Is Correlated with Target-Organ Damage Independent of Ambulatory Blood-Pressure Level in Patients with Non-Diabetic Chronic Kidney Disease. PLoS One 2015; 10:e0131546. [PMID: 26186336 PMCID: PMC4506060 DOI: 10.1371/journal.pone.0131546] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 06/03/2015] [Indexed: 01/14/2023] Open
Abstract
Background The impacts of blood pressure (BP) load on target-organ damage in patients with chronic kidney disease (CKD) are largely unclear. We examined whether BP load is correlated with target-organ damage (TOD) in Chinese CKD patients independent of BP level. Methods We recruited 1219 CKD patients admitted to our hospital division in this cross-sectional study. The TOD were measured by estimated glomerular filtration rate (eGFR), proteinuria, left ventricular mass index (LVMI) and carotid intima-media thickness (cIMT) in this study. Univariate and multivariate linear analyses were used to evaluate the relationship between systolic blood pressure (SBP) load, diastolic blood pressure (DBP) load and these renal, cardiovascular parameters. Results In multivariable-adjusted models, BP load and ambulatory BP levels both independently correlated with LVMI, eGFR and proteinuria in all groups of CKD patients (p<0.05), 24-h SBP correlated with cIMT only in non-diabetic CKD patients without hypertension (p<0.05), while nighttime SBP load was associated with cIMT only in non-diabetic CKD patients (p<0.05). Furthermore, nighttime SBP load additionally increased coefficient of determination (R2) and correlated with LVMI, proteinuria in non-diabetic CKD patients without hypertension (R2 = 0.034, P<0.001 and R2 = 0.012, P = 0.006 respectively) and LVMI, cIMT, eGFR in non-diabetic CKD patients with hypertension (R2>0.008, P<0.05) in multivariable-adjusted model which already including the 24-h BP. BP load did not refine this correlation based on the 24-h BP level in diabetic CKD patients. Conclusion Night-time SBP load was correlated with TOD in patients with non-diabetic chronic kidney disease independent of BP level.
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Affiliation(s)
- Cheng Wang
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Jun Zhang
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Wenjie Deng
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Wenyu Gong
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Xun Liu
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Zengchun Ye
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Hui Peng
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
| | - Tanqi Lou
- Division of Nephrology, Department of Medicine, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China
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9
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The angiotensin II type 1 receptor blocker olmesartan preferentially improves nocturnal hypertension and proteinuria in chronic kidney disease. Hypertens Res 2012; 36:262-9. [PMID: 23154587 DOI: 10.1038/hr.2012.184] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accumulated evidence suggests that an altered ambulatory blood pressure (BP) profile, particularly elevated nighttime BP, reflects target organ injury and is a better predictor of further cardiorenal risk than the clinic BP or daytime BP in hypertensive patients complicated by chronic kidney disease (CKD). In this study, we examined the beneficial effects of olmesartan, an angiotensin II type 1 receptor blocker (ARB), on ambulatory BP profiles and renal function in hypertensive CKD patients. Forty-six patients were randomly assigned to the olmesartan add-on group (n=23) or the non-ARB group (n=23). At baseline and after the 16-week treatment period, ambulatory BP monitoring was performed and renal function parameter measurements were collected. Although the baseline clinic BP levels and the after-treatment/baseline (A/B) ratios of clinic BP levels were similar in the olmesartan add-on and non-ARB groups, the A/B ratios of ambulatory 24-h and nighttime BP levels in the olmesartan add-on group were significantly lower. Furthermore, the A/B ratios of urinary protein, albumin and type IV collagen excretion in the olmesartan add-on group were significantly lower than those in the non-ARB group (urinary protein excretion, 0.72±0.41 vs. 1.45±1.48, P=0.030; urinary albumin excretion, 0.73±0.37 vs. 1.50±1.37, P=0.005; urinary type IV collagen excretion, 0.87±0.42 vs. 1.48±0.87, P=0.014) despite comparable A/B ratios for the estimated glomerular filtration rate in the two groups. These results indicate that in hypertensive patients with CKD, olmesartan add-on therapy improves the ambulatory BP profile via a preferential reduction in nighttime BP with concomitant renal injury inhibition.
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Wen KC, Gourishankar S. Evaluating the utility of ambulatory blood pressure monitoring in kidney transplant recipients. Clin Transplant 2012. [DOI: 10.1111/ctr.12009.] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin C. Wen
- Division of Nephrology and Immunology; Department of Medicine; University of Alberta; Edmonton; Alberta; Canada
| | - Sita Gourishankar
- Division of Nephrology and Immunology; Department of Medicine; University of Alberta; Edmonton; Alberta; Canada
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11
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Wen KC, Gourishankar S. Evaluating the utility of ambulatory blood pressure monitoring in kidney transplant recipients. Clin Transplant 2012; 26:E465-70. [DOI: 10.1111/ctr.12009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kevin C. Wen
- Division of Nephrology and Immunology; Department of Medicine; University of Alberta; Edmonton; Alberta; Canada
| | - Sita Gourishankar
- Division of Nephrology and Immunology; Department of Medicine; University of Alberta; Edmonton; Alberta; Canada
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12
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Kanaoka T, Tamura K, Ohsawa M, Yanagi M, Haku S, Wakui H, Maeda A, Dejima T, Azushima K, Mitsuhashi H, Okano Y, Fujikawa T, Toya Y, Mizushima S, Tochikubo O, Umemura S. Relationship of ambulatory blood pressure and the heart rate profile with renal function parameters in hypertensive patients with chronic kidney disease. Clin Exp Hypertens 2012; 34:264-9. [PMID: 22578052 DOI: 10.3109/10641963.2012.681082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Strict blood pressure (BP) control is reportedly important for the management of hypertensive patients with chronic kidney disease (CKD). The purpose of this cross-sectional study was to examine whether the variables of ambulatory BP and the heart rate (HR) profile, central hemodynamics, and arterial stiffness were closely related to the renal function parameters (urine albumin excretion rate [UACR] and estimated glomerular filtration rate [eGFR]) observed in 25 consecutive hospitalized hypertensive patients with CKD. There were significant positive relationships between UACR and 24-hour, daytime, and nighttime ambulatory systolic BP. In addition, there were significant negative relationships between UACR and 24-hour and daytime HR variability. The circulating B-type natriuretic peptide level and hemoglobin A1c were also positively related to UACR. With respect to eGFR, although the 24-hour and nighttime HR variability were positively associated with eGFR, the circulating pentosidine and nighttime HR had a negative relationship with eGFR. On the other hand, central hemodynamics and arterial stiffness did not exhibit any significant association with renal function parameters. These results indicate that ambulatory BP and the HR profile are closely modulated by renal function deterioration. Further studies are needed to investigate the causal relationship between ambulatory BP and the HR profile and renal function parameters in hypertensive patients with CKD.
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Affiliation(s)
- Tomohiko Kanaoka
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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13
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Kanaoka T, Tamura K, Ohsawa M, Wakui H, Maeda A, Dejima T, Azushima K, Haku S, Mitsuhashi H, Yanagi M, Oshikawa J, Uneda K, Aoki K, Fujikawa T, Toya Y, Uchino K, Umemura S. Effects of Aliskiren-Based Therapy on Ambulatory Blood Pressure Profile, Central Hemodynamics, and Arterial Stiffness in Nondiabetic Mild to Moderate Hypertensive Patients. J Clin Hypertens (Greenwich) 2012; 14:522-9. [DOI: 10.1111/j.1751-7176.2012.00640.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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14
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Kanaoka T, Tamura K, Moriya T, Tanaka K, Konno Y, Kondoh S, Toyoda M, Umezono T, Fujikawa T, Ohsawa M, Dejima T, Maeda A, Wakui H, Haku S, Yanagi M, Mitsuhashi H, Ozawa M, Okano Y, Ogawa N, Yamakawa T, Mizushima S, Suzuki D, Umemura S. Effects of Multiple Factorial Intervention on Ambulatory BP Profile and Renal Function in Hypertensive Type 2 Diabetic Patients with Overt Nephropathy – A Pilot Study. Clin Exp Hypertens 2011; 33:255-63. [DOI: 10.3109/10641963.2011.583971] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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15
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Parati G, Bilo G. Should 24-h ambulatory blood pressure monitoring be done in every patient with diabetes? Diabetes Care 2009; 32 Suppl 2:S298-304. [PMID: 19875569 PMCID: PMC2811450 DOI: 10.2337/dc09-s326] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Gianfranco Parati
- Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy.
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Masuda SI, Tamura K, Wakui H, Kanaoka T, Ohsawa M, Maeda A, Dejima T, Yanagi M, Azuma K, Umemura S. Effects of angiotensin II type 1 receptor blocker on ambulatory blood pressure variability in hypertensive patients with overt diabetic nephropathy. Hypertens Res 2009; 32:950-5. [PMID: 19713965 DOI: 10.1038/hr.2009.131] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Previous studies have shown increases in ambulatory short-term blood pressure (BP) variability to be related to cardiovascular disease. In this study, we examined whether the angiotensin II type 1 receptor blocker (ARB) would improve ambulatory short-term BP variability in hypertensive patients with diabetic nephropathy. A total of 30 patients with type II diabetes, along with hypertension and overt nephropathy, were enrolled in this randomized, two-period, crossover trial of 12 weeks of treatment with losartan (50 mg daily) and telmisartan (40 mg daily). At baseline and at the end of each treatment period, 24-h ambulatory BP monitoring with power spectral analysis of heart rate and measurements of proteinuria, estimated glomerular filtration rate and brachial-ankle pulse wave velocity (baPWV) were performed. After 12 weeks of treatment, 24-h, daytime and nighttime short-term BP variability, assessed on the basis of the coefficient of variation of ambulatory BP, was significantly decreased by telmisartan. Both losartan and telmisartan reduced urinary protein excretion and baPWV. However, compared with losartan, telmisartan significantly decreased urinary protein excretion, baPWV and low-frequency (LF)-to-high-frequency (HF) ratio, an index of sympathovagal balance. Multiple regression analysis showed significant correlations between urinary protein excretion and baPWV, 24-h LF-to-HF ratio, nighttime systolic BP and 24-h short-term systolic BP variability. These results suggest that ARB, particularly telmisartan, is effective in reducing proteinuria in hypertensive patients with overt diabetic nephropathy, partly through inhibitory effects on ambulatory short-term BP variability and sympathetic nerve activity, in addition to its longer duration of action on nighttime BP reduction.
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Affiliation(s)
- Shin-ichiro Masuda
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Ozawa M, Tamura K, Iwatsubo K, Matsushita K, Sakai M, Tsurumi-Ikeya Y, Azuma K, Shigenaga A, Okano Y, Masuda S, Wakui H, Ishigami T, Umemura S. Ambulatory blood pressure variability is increased in diabetic hypertensives. Clin Exp Hypertens 2008; 30:213-24. [PMID: 18425701 DOI: 10.1080/10641960802068477] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to examine the possible difference in the 24-hr BP profile--including short-term BP variability, assessed as the standard deviation--between diabetic and non-diabetic hypertensives. We measured 24-hr ambulatory BP in 11 diabetic hypertensives (diabetic HT) and 10 non-diabetic hypertensives (non-diabetic HT) who were hospitalized for the educational program in our hospital and were under stable salt intake. Renal function and sleep apnea were also estimated. There were no significant differences in 24-hr systolic BP (141 mmHg vs. 135 mmHg, ns), daytime systolic BP (143 mmHg vs. 138 mmHg, ns), and nighttime systolic BP (135 mmHg vs. 130 mmHg, ns) between diabetic HT and non-diabetic HT. The values of 24-hr HR (69.7 beats/min vs. 65.2 beats/min, ns) and 24-hr HR variability (9.9 beats/min vs. 10.1 beats/min, ns) were also similar between the groups. Interestingly, diabetic HT had a significantly greater 24-hr systolic and diastolic BP variability than non-diabetic HT (18.2 mmHg vs. 14.5 mmHg, p < 0.05; 11.5 mmHg vs. 9.6 mmHg, p < 0.05, respectively). The values for creatinine clearance, urinary protein excretion, and apnea-hypopnea index were similar between the groups. Bivariate linear regression analysis demonstrated that fasting blood glucose was the primary determinant of 24-hr diastolic BP variability (r = 0.661, p < 0.01). Multiple stepwise regression analysis revealed that fasting blood glucose was a significant and independent contributor to 24-hr systolic BP variability (r = 0.501, p < 0.05). Taken together, these results demonstrate that BP variability is increased in diabetic hypertensives. Furthermore, it is possible that an elevation of fasting blood glucose may contribute to the enhanced BP variability in hypertensives.
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Affiliation(s)
- Motoko Ozawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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