Nocturnal dosing and chronic kidney disease progression: new insights

PURPOSE OF REVIEW: Several studies have identified the presence of altered diurnal blood pressure patterns, specifically elevated nighttime blood pressure in patients with chronic kidney disease. The lack of nocturnal decline in blood pressure is associated with markers of hypertensive target organ damage and predictive of long-term clinical outcomes. The purpose of this review is to summarize the literature in this area and explore the potential for use of nighttime blood pressure for improving risk stratification and as a therapeutic target. RECENT FINDINGS: The mechanisms of persistent elevation of blood pressure at night in chronic kidney disease are likely to be multifactorial, including altered sodium handling and sympathetic activation among others. Elevated nocturnal blood pressures have been shown to be associated with increased adverse clinical outcomes. Recent studies demonstrate that it is feasible to lower nocturnal blood pressure by modifying the time of administration of antihypertensive medications. SUMMARY: Currently, clinical blood pressure measurements are assessed and targeted for drug therapy. This article shows the importance of measuring ambulatory blood pressures, specifically nocturnal blood pressures to improve risk stratification. More research needs to be done to identify interventions that lower nighttime blood pressure, and test their efficacy in improving clinical outcomes.