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  • Title: Morning hypertension in chronic kidney disease is sustained type, but not surge type.
    Author: Mizuno M, Fukuda M, Miura T, Wakamatsu T, Naito T, Sato R, Togawa H, Sasakawa Y, Tomonari T, Ono M, Kato Y, Ichikawa T, Shirasawa Y, Ito A, Yoshida A, Kimura G.
    Journal: Blood Press Monit; 2012 Feb; 17(1):20-3. PubMed ID: 22218220.
    Abstract:
    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. MATERIALS AND 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. CONCLUSION: 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.
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