Association Between Change in Central Nocturnal Blood Pressure and Urine Albumin-Creatinine Ratio by a Valsartan/Amlodipine Combination: A CPET Study.

Abstract

BACKGROUND:

We aimed to assess the association of changes in brachial or central nocturnal systolic blood pressure (SBP) with change in urine albumin-creatinine ratio (UACR) by a valsartan/amlodipine combination (80/5 mg) therapy in hypertensive patients.

METHODS:

Twenty-three patients (age range, 47-78 years; mean, 68.0 years; 35% men, 65% with chronic kidney disease) with clinic brachial BP ≥140/90 mm Hg were treated with valsartan/amlodipine combination therapy for 16 weeks. At baseline and 16 weeks later, we measured brachial and central nocturnal SBP using an oscillometric Mobil-O-Graph device and UACR by spot urine in 23 patients.

RESULTS:

The changes in brachial nocturnal SBP (r = 0.445, P = 0.033) and those in central nocturnal SBP (r = 0.616, P = 0.002) were significantly associated with change in UACR by intervention. In multivariable-adjusted multiple regression analyses including changes in both brachial and central nocturnal SBP jointly, only central nocturnal SBP change retained a statistically significant association with change in UACR (β = 0.919, P = 0.020).

CONCLUSIONS:

Lowering central nocturnal SBP by a valsartan/amlodipine combination therapy was associated with reduction of UACR, independently of brachial nocturnal SBP reduction. Central nocturnal SBP may be a therapeutic target to protect the kidney. A larger scale interventional study will be needed to confirm the kidney protection conferred by lowering central nocturnal SBP.

CLINICAL TRIALS REGISTRATION:

Trial Number UMIN000013519.

• Authors: Takeshi Fujiwara, Yuichiro Yano, Satoshi Hoshide, Hiroshi Kanegae, Junichiro Hashimoto, Kazuomi Kario
• Journal: American journal of hypertension (Am J Hypertens) Vol. 31 Issue 9 Pg. 995-1001 (08 03 2018) ISSN: 1941-7225 [Electronic] United States
• PMID: 29850782 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Amlodipine, Valsartan Drug Combination
• Angiotensin II Type 1 Receptor Blockers
• Antihypertensive Agents
• Biomarkers
• Calcium Channel Blockers
• Creatinine

Topics

• Aged
• Albuminuria (etiology, prevention & control, urine)
• Amlodipine, Valsartan Drug Combination (administration & dosage)
• Angiotensin II Type 1 Receptor Blockers (administration & dosage)
• Antihypertensive Agents (administration & dosage)
• Biomarkers (urine)
• Blood Pressure (drug effects)
• Calcium Channel Blockers (administration & dosage)
• Circadian Rhythm (drug effects)
• Creatinine (urine)
• Drug Administration Schedule
• Female
• Humans
• Hypertension (complications, drug therapy, physiopathology)
• Kidney Diseases (etiology, prevention & control, urine)
• Male
• Middle Aged
• Time Factors
• Treatment Outcome