Abstract
An altered ambulatory blood pressure (BP) and heart rate (HR) profile is related to chronic kidney disease (CKD) and cardiorenal syndrome. In this study, we examined the effects of aliskiren, when added to angiotensin II type 1 receptor blockers, on ambulatory BP and cardiorenal function in CKD. Thirty-six hypertensive CKD patients were randomly assigned to the aliskiren add-on group (n = 18) or the benazepril add-on group (n = 18). Ambulatory BP and cardiorenal function parameters were measured at baseline and 24 weeks after treatment. Compared with the benazepril group, nighttime systolic BP variability in the aliskiren group was lower after treatment. Albuminuria was decreased in the aliskiren group, but not in the benazepril group. In addition, left ventricular mass index (LVMI) was significantly lower in the aliskiren group than in the benazepril group after treatment. In the aliskiren group, multivariate linear regression analysis showed an association between changes in albuminuria and changes in nighttime systolic BP. Furthermore, there were associations between changes in LVMI and changes in daytime HR variability, as well as between changes in LVMI and changes in plasma aldosterone concentration. These results suggest that aliskiren add-on therapy may be beneficial for suppression of renal deterioration and pathological cardiac remodeling through an improvement that is effected in ambulatory BP and HR profiles.
Highlights
Hypertensive patients with chronic kidney disease (CKD) and diabetes are increasing in number, and cardiovascular complications are the most common cause of death in these hypertensive patients
The results of the present study showed that add-on treatment with either aliskiren or benazepril significantly decreased clinic blood pressure (BP) in hypertensive CKD patients who had been already treated with
The results of our previous cross-sectional study showed that short-term BP variability was significantly increased in CKD patients with coronary artery disease and, in particular, that an increase in nighttime short-term BP variability was strongly associated with the degree of left ventricular (LV)
Summary
Hypertensive patients with chronic kidney disease (CKD) and diabetes are increasing in number, and cardiovascular complications are the most common cause of death in these hypertensive patients. It would be a considerable advance to elucidate the mechanisms involved in the renal deterioration and cardiovascular events associated with hypertension complicated by CKD and diabetes and to identify therapeutic approaches that inhibit these cardiorenal consequences. Ambulatory BP monitoring has allowed an accurate diagnosis of hypertension [1,2] and determination of the BP and heart rate (HR) circadian rhythms under different pathophysiological conditions, including hypertension and CKD, and it may afford a more accurate prognosis than clinical. The circadian BP pattern in hypertensive patients with CKD has been found to exhibit a blunted nocturnal decrease in BP, which is associated with autonomic neuropathy and nephropathy [6,7]. The loss of nocturnal BP dipping has been considered to be a risk factor for the progression of nephropathy and to be of prognostic value with respect to target organ damage and cardiovascular morbidity in CKD patients [5,8,9,10]
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