Nighttime blood pressure and nocturnal dipping are associated with daytime urinary sodium excretion in African subjects
Nighttime blood pressure and nocturnal dipping are associated with daytime urinary sodium excretion in African subjects
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DOI：
10.1161/hypertensionaha.107.105510
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发表时间：
2008-04-01
期刊：
影响因子：
8.3
通讯作者：
Burnier, Michel
中科院分区：
文献类型：
--
作者：
Bankir, Lise;Bochud, Murielle;Burnier, Michel
血压（BP）遵循昼夜节律，夜间血压值比白天低10%至15%。没有夜间血压下降（下降）与靶器官损伤有关，但对下降的决定因素知之甚少。我们评估了夜间血压和下降是否与昼夜钠排泄模式相关。同时测量了来自73个家庭的325名非洲裔个体的动态血压和日间及夜间尿电解质排泄。当将尿钠排泄率的昼夜比值分为性别特异性三分位数时，与三分位数3的受试者相比，三分位数1（比值最低）的受试者年龄大6.5岁，夜间收缩压（SBP）高9.8 mm Hg，SBP下降（以日间值的百分比表示）低23%（趋势P < 0.01）。校正年龄后，三分位数之间的SBP差异降至5.4 mm Hg（P = 0.002），SBP下降差异降至17%（P = 0.05）。舒张压在三分位数之间也有类似的趋势。在多变量分析中，白天尿钠和钾浓度与夜间收缩压和收缩压下降独立相关（P < 0.05）。基于大量受试者的这些数据表明，白天排泄钠的能力是夜间BP和下降的重要决定因素。这一观察结果可能有助于我们了解夜间血压的病理生理学和临床后果，并制定治疗策略，使高血压患者的血压下降正常化。
Blood pressure ( BP) follows a circadian rhythm, with 10% to 15% lower values during nighttime than during daytime. The absence of a nocturnal BP decrease ( dipping) is associated with target organ damage, but the determinants of dipping are poorly understood. We assessed whether the nighttime BP and the dipping are associated with the circadian pattern of sodium excretion. Ambulatory BP and daytime and nighttime urinary electrolyte excretion were measured simultaneously in 325 individuals of African descent from 73 families. When divided into sex-specific tertiles of day: night ratios of urinary sodium excretion rate, subjects in tertile 1 ( with the lowest ratio) were 6.5 years older and had a 9.8-mm Hg higher nighttime systolic BP (SBP) and a 23% lower SBP dipping ( expressed in percentage of day value) compared with subjects in tertile 3 ( P for trend < 0.01). After adjustment for age, the SBP difference across tertiles decreased to 5.4 mm Hg ( P = 0.002), and the SBP dipping difference decreased to 17% ( P = 0.05). A similar trend across tertiles was found with diastolic BP. In multivariate analyses, daytime urinary sodium and potassium concentrations were independently associated with nighttime SBP and SBP dipping ( P < 0.05 for each). These data, based on a large number of subjects, suggest that the capacity to excrete sodium during daytime is a significant determinant of nocturnal BP and dipping. This observation may help us to understand the pathophysiology and clinical consequences of nighttime BP and to develop therapeutic strategies to normalize the dipping profile in hypertensive patients.