Hypothesis on renal mechanism of non-dipper pattern of circadian blood pressure rhythm

In some patients with sodium sensitive type of hypertension or kidney disease, blood pressure (BP) fails to dip during night and they have been called “non-dipper”, whereas those with a normal nocturnal dip are called “dipper”. Many investigators reported that non-dippers were certainly exposed to greater risks of cardiovascular complications. We have recently proposed that kidneys play an important role in determining the circadian rhythm of BP, in addition to long-term BP regulation. When sodium intake is high, the defect in sodium excretory capability of kidneys becomes evident, making BP during night elevated, that is non-dipper, in order to compensate for diminished natriuresis during daytime and to enhance pressure–natriuresis during night. Therefore, as renal function deteriorates, longer duration may be required before BP begins to dip during night. Non-dipping may be one mechanism causing cardiovascular events in chronic kidney disease.