Association between nondipper behavior and serum calcium in hypertensive patients with mild-to-moderate chronic renal...

Area of Science:

• Nephrology
• Cardiology
• Hypertension Research

Background:

• A nondipping blood pressure (BP) pattern is associated with increased risk of end-organ damage, cardiovascular events, and mortality.
• The mechanisms underlying blunted nocturnal BP fall are complex and multifactorial.
• Understanding factors contributing to nondipping is crucial for managing hypertensive patients.

Purpose of the Study:

• To investigate the association between total corrected serum calcium and ionic calcium (iCa) with a blunted nocturnal BP fall.
• To examine these associations in both treated and untreated hypertensive patients across stages 1-3 of NKF KDOQI.
• To explore the relationship between arterial stiffness, kidney function, and nondipping BP patterns.

Main Methods:

• A cohort of 231 essential hypertensive patients underwent clinical evaluation and 24-hour ambulatory blood pressure monitoring.
• Patients were categorized into dippers (normal nocturnal BP fall) and nondippers (blunted nocturnal BP fall).
• Statistical analyses included correlation, regression, and comparison of groups based on BP patterns and kidney function.

Main Results:

• In nondippers, ionic calcium (iCa) showed significant correlations with 24-hour systolic BP, diurnal SBP, and 24-hour pulse pressure.
• Ambulatory arterial stiffness index (AASI) and 24-hour pulse pressure were higher in nondippers.
• Nondippers had a higher prevalence of reduced estimated glomerular filtration rate (eGFR < 60 mL/minute/1.73 m2), and lower eGFR was independently associated with nondipper status.

Conclusions:

• Serum iCa may play a role in the pathogenesis of the nondipping BP pattern.
• Increased large artery stiffness might mediate the adverse cardiovascular effects of nondipping.
• Hypertensive patients with stage 3 NKF KDOQI disease exhibit a greater loss of circadian BP rhythm.