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Loss of Nocturnal Blood Pressure Fall in Patients With Renal Impairment—Reply
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In reply
We appreciate the insightful comments of Ben-Dov and Bursztyn and Portaluppi regarding our recent investigation of the association of nondipping with a subsequent decline in glomerular filtration rate (GFR).
Ben-Dov and Bursztyn provide evidence to suggest that nondipping may be a subtle manifestation of early nephropathy and may be amenable to reversal by agents that address "salt-sensitive" states, namely diuretics, as opposed to inhibitors of the renin-angiotensin-aldosterone (RAAS) system as we suggested. This is a possibility that we cannot dispute. Creatinine-based GFR formulas are imperfect and we lacked urine microalbumin measurements in most of our patients, so it is plausible that nondipping may have resulted from occult baseline nephropathy in some of our patients. Furthermore, given recent data suggesting that much of the renoprotection conferred by blockade of the RAAS comes from BP reduction rather than pathway-specific glomerular protection,1 diuretics may be an effective first-line treatment in hypertensive . . . [Full Text of this Article]
AUTHOR INFORMATION
Michael B. Davidson, DO;
Daniel J. Brotman, MD
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