Petersen LJ, Petersen JR, Talleruphus U et al
Ambulatory diastolic blood pressure lower than 80 mm Hg
postpones decline in renal function in patients with chronic renal
disease
16th Scientific Meeting of the International Society of Hypertension
ISH Abstract Book
(Jun) 16: 1996
The goal of this study was to evaluate associations
between 24-hour ambulatory blood pressure and the rate of decline in renal
function in patients with hypertension and chronic renal disease.
A small number of patients (n=22) with hypertension
(>140/95) and chronic renal disease (SCr>150 micromol/l) were monitored with
a 24-hour ambulatory system. GFR was measured using the EDTA
infusion method. Patients with ambulatory
BP < 80mm Hg had a considerably slower rate of progression of their renal
disease (i.e. >80 mm Hg rate was -1.7 ml/min/1.73 m2/month vs. -0.26
ml/min/1.73 m2/month, repectively. This rate change between groups
occurred without regard to dipper vs. non-dipper. If systolic BP upper
limit cutoff was 150 the difference between groups was l.4 ml/min. The
differences in the rates was significant only at the 0.02 level for the
diastolic and 0.07 for the systolic groups. Though not noted in the
abstract, the primary, but not sole, drug therapy was ACEI and not all the
patients who achieved the lower DBP were in the ACEI group.
Comment: This was one of several presentations relating to a
thesis that a "very
low" DBP (<80 mmHg) may be as or more important than which drug therapy is
used to acheive the BP goal. There were no reported untoward
side-effects with the the low DBP. Finally, This was not a long term study
(greater than 1 year or more) and larger and longer studies need to be
performed.
(Richard Dart, M.D., Marshfield Clinic, Marshfield, WI)
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16th Scientific Meeting of the International Society of Hypertension
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