Portaluppi F, Vergnani L, Manfredini R, degli Uberti E C, Fersini C
Hypertension Unit, University of Ferrara, Italy.
Am J Hypertens. 1995 Jul;8(7):719-26. doi: 10.1016/0895-7061(95)00124-8.
Nocturnal hypertension is frequently observed in chronic renal failure and contributes to the risk of target organ damages. We assessed whether antihypertensive therapy may restore a nocturnal blood pressure (BP) fall in this condition. A sustained-release oral formulation (SRO) of isradipine was used, and the possible differences in the response to morning nu evening dosing were also investigated. Sixteen hypertensive patients with chronic renal failure due to parenchymal kidney disease were studied after 2 weeks of single-blind placebo runin. According to the double-blind, randomized, cross-over design, they received 5 mg isradipine SRO at 08:00, or at 20:00 for 4 weeks, separated by a single-blind placebo period of 2 weeks. A 24-h BP monitoring at 10-min intervals was carried out at the end of each treatment using a SpaceLabs 90207 instrument. Under placebo, blunt BP profiles were observed, whereas HR showed a mean nocturnal fall of 17.4%, which remained unaltered after isradipine. Both isradipine treatments were equally effective in reducing the mean 24-h BP levels. However, the evening regimen showed a more pronounced effect during the night. The mean nocturnal fall in systolic/diastolic BP represented 4.8/8.7% and 7.5/10.9% of the corresponding daytime mean after morning and evening dosing, respectively. Only the evening administration reset the normal synchronization of the 24-h BP and HR profiles. Our findings demonstrate that antihypertensive treatment may restore a nocturnal BP fall in renal patients. An evening regimen of isradipine SRO seems more apt than a morning regimen to obtain this therapeutic goal.
夜间高血压在慢性肾衰竭中很常见，并会增加靶器官损害的风险。我们评估了抗高血压治疗是否能恢复这种情况下的夜间血压下降。使用了伊拉地平缓释口服制剂（SRO），并研究了早晚给药反应的可能差异。16名因实质性肾病导致慢性肾衰竭的高血压患者在进行了2周的单盲安慰剂导入期后接受研究。根据双盲、随机、交叉设计，他们在08:00或20:00接受5mg伊拉地平SRO治疗，为期4周，中间间隔2周的单盲安慰剂期。在每次治疗结束时，使用SpaceLabs 90207仪器以10分钟的间隔进行24小时血压监测。在安慰剂治疗下，观察到血压曲线变钝，而心率夜间平均下降17.4%，在服用伊拉地平后保持不变。两种伊拉地平治疗在降低24小时平均血压水平方面同样有效。然而，晚间给药方案在夜间显示出更明显的效果。早晨和晚间给药后，收缩压/舒张压的夜间平均下降分别占相应白天平均值的4.8/8.7%和7.5/10.9%。只有晚间给药恢复了24小时血压和心率曲线的正常同步。我们的研究结果表明，抗高血压治疗可以恢复肾病患者的夜间血压下降。伊拉地平SRO的晚间给药方案似乎比早晨给药方案更适合实现这一治疗目标。
