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Exogenous glucocorticoid eliminates or reverses circadian blood pressure variations
Insights
Glucocorticoid treatment disrupts the normal nocturnal blood pressure dip in patients with chronic glomerulonephritis (CGN) and systemic lupus erythematosus (SLE). This suggests the hypothalamo-pituitary-adrenal axis influences circadian blood pressure rhythms.
Area of Science:
- Endocrinology
- Cardiology
- Nephrology
Background:
- Circadian variations in blood pressure are well-documented in essential hypertension.
- Patients with chronic glomerulonephritis (CGN) often exhibit similar blood pressure patterns to those with essential hypertension.
- The influence of glucocorticoids on these circadian rhythms is not fully understood.
Purpose of the Study:
- To investigate the effect of glucocorticoid treatment on the circadian variations of blood pressure.
- To compare blood pressure and heart rate patterns in patients with and without glucocorticoid treatment.
Main Methods:
- Observational study comparing blood pressure and heart rate patterns.
- Included patients with essential hypertension, CGN, and systemic lupus erythematosus (SLE).
- Examined circadian rhythms before and during glucocorticoid (prednisolone) treatment in 10 CGN/SLE patients.
Main Results:
- Untreated patients and those on antihypertensive drugs showed a normal nocturnal blood pressure fall.
- Glucocorticoid-treated CGN/SLE patients lacked the nocturnal blood pressure fall, often showing a morning peak.
- Prednisolone abolished the nocturnal blood pressure dip, while the nocturnal heart rate fall persisted.
- Correlation between blood pressure and heart rate was lost during glucocorticoid treatment.
Conclusions:
- Glucocorticoid therapy significantly alters circadian blood pressure patterns, abolishing the nocturnal dip.
- The hypothalamo-pituitary-adrenal axis, likely via the autonomic nervous system, influences circadian blood pressure regulation.
- These findings have implications for managing hypertension in patients on glucocorticoid therapy.
Abstract:
The effect of glucocorticoid on circadian variations of blood pressure was examined. In untreated patients with essential hypertension, a clear nocturnal fall in blood pressure and heart rate was observed and this was unaffected by combined treatment with antihypertensive drugs. The circadian blood pressure variation in patients with chronic glomerulonephritis (CGN) not receiving glucocorticoid treatment was essentially the same as that in patients with essential hypertension. In both groups there was a positive correlation between blood pressure and heart rate. On the other hand, in patients with CGN and systemic lupus erythematosus (SLE) who were treated with glucocorticoid, there was no nocturnal fall in blood pressure, and often a significant rise. In these patients the blood pressure was lowest in the afternoon and began to rise from then, and during the night, attaining a peak level in the morning. Despite this changed pattern of blood pressure variations, the heart rate in these patients was clearly reduced at night. In 10 patients with CGN and SLE, circadian rhythm of blood pressure and heart rate was examined before and during treatment with prednisolone (40.2 +/- 17.0 mg/day for 58.0 +/- 19.4 days, mean +/- s.d.). Prednisolone abolished the nocturnal fall of blood pressure, while the nocturnal fall of heart rate remained. There was no correlation between blood pressure and heart rate in patients with glucocorticoid treatment. These results suggest that the circadian blood pressure variation is influenced by the hypothalamo-pituitary-adrenal axis, probably through its action on the autonomic nervous system.