Nocturnal Blood Pressure and Hypertension - Central and Peripheral 24-h Blood Pressure.
Nocturnal Blood Pressure and Hypertension - Central and Peripheral 24-h Blood Pressure.
A new study have shown that high night time blood pressure (BP) and/or non-dipping (lack of
 fall in BP during night time) is a strong predictor for the risk of cardiovascular disease
 and mortality in patients with hypertension. Three factors seem to affect the night time BP:
 chronic kidney disease, obstructive sleep apnea (OSA) and the way ambulatory blood pressure
 is monitored.

 Hypothesis:

 Central 24-h blood pressure monitoring is a better way of monitoring blood pressure than
 conventional peripheral monitoring.

 In hypertension, chronic kidney disease and obstructive sleep apnea (OSA) the night time
 blood pressure is elevated, and is OSA the elevation is correlated to the severity of OSA.

 In OSA the kidneys handling of salt and water is disturbed. In OSA there is disturbances in
 hormonal balance.
75 patients with hypertension and chronic kidney disease (CKD I-II) and 75 healthy subjects
 is examined with both central and peripheral 24 hours blood pressure monitoring, 1 night home
 polygraphy to determine whether the subject has obstructive sleep apnea (OSA), and if so the
 degree (apnea hypopnea index, AHI), blood and urine samples to determine levels of urine
 aquaporine2 (u-AQP2), urine endothelial sodium channel (u-EnaC), plasma renin concentration
 (PRC), plasma angiotensin II (p-AngII), plasma aldosterone (p-aldosterone), plasma
 vasopressin (p-AVP) and plasma endothelin (p-endothelin).

 Hypothesis:

 Central 24-h BP monitoring provides another measure of daily fluctuations in blood pressure
 than peripheral 24-h BP monitoring, because this measurement is painless and does not
 interfere with activities in the daytime or night-time sleep.

 In hypertension, chronic kidney disease and OSA the decease in nocturnal BP is lower than i
 healthy subjects.

 In OSA the decrease in the nocturnal BP is inversely correlated with the severity of OSA.

 In OSA is the renal tubular absorption of water and sodium abnormal with increased tubular
 absorption of water with AQP2 and of sodium by ENAC.

 In OSA, there is increased activity of the renin-angiotensin-aldosterone system, increased
 endothelin in plasma and increased vasopressin in plasma.
Group 1:

 Inclusion Criteria:

 -  Chronic kidney disease (CKD stage I and II), estimated glomerule filtration rate
 (eGFR) 60-90 ml/min/1.73 m2 or eGFR> 90 ml/min/1.73 m2 and proteinuria or other signs
 of kidney damage.

 -  Hypertension (BP by ambulatory or home blood pressure> 135/85 mmHg, or consultation
 blood pressure> 140/90 mmHg).

 -  Both men and women

 -  55-70 years

 -  A completed consent form

 Exclusion Criteria:

 -  Lack of desire to participate

 -  In the treatment of OSA

 -  Malignant disease

 -  Abuse of drugs or alcohol

 -  Pregnant and breastfeeding

 -  Incompensated heart failure

 -  Atrial fibrillation

 -  Liver disease (Alanine aminotransferase (ALT)> 200)

 -  Severe chronic obstructive pulmonary disease (COPD) (Forced expiratory volume in 1
 second <50% predicted)

 -  eGFR <60 ml/min/1.73 m2

 -  Blood pressure difference between the right and left arm> 10/10 mmHg

 Group 2 - Healthy subjects

 Inclusion Criteria:

 -  Healthy subjects men and women

 -  age 55 - 70 years

 -  Body mass index within the normal range, between 18.5 to 25.0 kg/m2

 Exclusion Criteria:

 -  Arterial hypertension, ambulatory blood pressure> 130 mmHg systolic and / or 80 mmHg
 diastolic.

 -  a history or clinical signs of cardial, pulmonary, hepato, renal, endocrine,
 cerebral or neoplastic disorders

 -  Alcohol abuse, ie. > 14 drinks / week for women and> 21/uge for men

 -  Substance abuse

 -  Medical treatment apart from oral contraceptives

 -  Smoking

 -  Pregnancy or breastfeeding

 -  Lack of desire to participate

 -  Clinically significant, discrepant results of blood or urine sample at inclusion
 study (B-hemoglobin and B-White blood cell count, p-sodium, p-potassium,
 p-creatinine, p-ALT, p-bilirubin , p-Alkaline phosphatase, p-cholesterol,
 p-albumin or b-glucose and urine for hematuria, albuminuria or glucosuria)

 -  Clinically significant variations in the electrocardiogram

 -  Blood Donation for the past month preceding the day on the first attempt sequence

 -  Blood pressure difference between the right and left arm> 10/10 mmHg.