Nocturnal Blood Pressure and Hypertension - Central and Peripheral 24-h Blood Pressure. (HOSA)

Nocturnal Blood Pressure in Hypertension, Obstructive Sleep Apnea and Healthy Subjects - 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.

Study Overview

• Status: Unknown
• Conditions: Hypertension; Obstructive Sleep Apnea; Chronic Kidneys Disease

Detailed Description

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.

• Study Type: Observational
• Enrollment (Anticipated): 150

Contacts and Locations

Study Locations

• Denmark
  • Holstebro, Denmark, 7500
    • Department of Medical Research and Medicine, Holstebro Regional Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 55 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Group 1: 75 patients with hypertension, recruited from another study in the Holstebro Area, contacted by letter.

Group 2: healthy subjects are recruited though posters in public and private companies as well as advertising in local media.

Description

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.

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
hypertension; 75 patients with hypertension and chronic kidney disease (CKD stage I-II)
healthy subjects; 75 healthy subjects

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
decrease in central systolic blood pressure at night	The difference in the decrease in systolic BP at night by peripheral 24-h BP between patients with hypertension and healthy subjects.	< 24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
decrease in central systolic blood pressure at night	The difference in the decrease in systolic BP at night by the central 24-h BP between patients with hypertension and healthy subjects.	< 24 hours
difference i blood pressure levels throughout the day	The difference in systolic blood pressure and diastolic blood pressure throughout the day, in the daytime and in nighttime between peripheral 24-h and central 24-h monitoring in both patients and healthy.	< 24 hours
The correlation between the decrease in nighttime BP on one side and severity of OSA and BP in the daytime on the other.	The correlation between the decrease in nighttime BP on one side and severity of OSA and BP in the daytime on the other.	< 24 hours
u-AQP2 and u-ENac	In 24-h urine samples	24 hours
PRC, p-AngII, p-aldosterone, p-AVP, p-endothelin	blood samples	< 1 hour

Collaborators and Investigators

• Sponsor: Erling Bjerregaard Pedersen

Study record dates

Study Major Dates

• Study Start: January 1, 2014
• Primary Completion (Anticipated): December 1, 2015
• Study Completion (Anticipated): December 1, 2017

Study Registration Dates

• First Submitted: March 1, 2014
• First Submitted That Met QC Criteria: March 1, 2014
• First Posted (Estimate): March 5, 2014

Study Record Updates

• Last Update Posted (Estimate): October 9, 2014
• Last Update Submitted That Met QC Criteria: October 8, 2014
• Last Verified: October 1, 2014

More Information

Terms related to this study

• Keywords: hypertension; obstructive sleep apnea; central blood pressure; 24-h blood pressure; peripheral blood pressure; chronic kidneys disease
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Vascular Diseases; Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Urologic Diseases; Renal Insufficiency; Signs and Symptoms, Respiratory; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Hypertension; Kidney Diseases; Renal Insufficiency, Chronic; Apnea
• Other Study ID Numbers: BGH-2-2013; M-2013-303-13 (Other Identifier: The Regional Committee of health Reseach Ethics)