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J Hypertens. 2013 Jun;31(6):1233-8. doi: 10.1097/HJH.0b013e32836043c9.

Angiotensin receptor blockers regulate the synchronization of circadian rhythms in heart rate and blood pressure.

Author information

1
Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 467–8601 Nagoya, Japan.

Abstract

OBJECTIVE:

The sympathetic nervous system plays an important role in blood pressure regulation even in the early stages of chronic kidney disease (CKD).

METHODS:

To understand the role of the sympathetic system, we examined the relationship between day/night ratios of both heart rate (HR) and mean arterial pressure (MAP) as well as HR variability (HRV, SD) before and during an 8-week treatment with the angiotensin II receptor blocker (ARB), olmesartan, in 45 patients with CKD.

RESULTS:

The day/night HR ratio strongly correlated with the day/night MAP ratio before and during ARB treatment. The ratio of [day/night HR ratio] over [day/night MAP ratio] was increased as renal function deteriorated at baseline (r = -0.31, P = 0.04), and it was attenuated (1.10 ± 0.10 to 1.06 ± 0.10; P = 0.04) and became independent of renal function during ARB treatment (r = -0.04, P = 0.8). ARB increased both the day/night HR ratio (1.17 ± 0.09 to 1.21 ± 0.13; P = 0.04) and HRV (10.6 ± 2.9 to 11.7 ± 4.2; P = 0.04), which were lower when baseline renal function deteriorated.

CONCLUSION:

The present study indicates that there exists a close correlation in circadian rhythms between HR and MAP in CKD. Synchronization between the two rhythms was progressively lost as renal function deteriorated, and ARB partly restored the synchronization. These findings suggest that the sympathetic nervous system is activated as renal function deteriorates, and ARB may suppress its activation.

PMID:
23511341
DOI:
10.1097/HJH.0b013e32836043c9
[Indexed for MEDLINE]

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