Natriuretic Peptide-Renin-Angiotensin-Aldosterone System Rhythm Axis and Nocturnal Blood Pressure
University of Alabama at Birmingham
Summary
Obese individuals have a higher prevalence of nocturnal hypertension and non-dipping blood pressure (BP). These conditions are associated with an increased risk of cardiovascular (CV) events and death. Natriuretic Peptides (NPs) are hormones produced by the heart which directly regulate BP by causing dilation of blood vessels and by removing sodium and water from the body. NPs have a 24-hour day-night rhythm and this controls the day-night rhythm of BP as well. The NP-BP rhythm relationship is broken down in obese individuals. Obese individuals also have lower circulating NP levels. Lower circulating levels of NPs and elevated renin hormone (a part of the Renin-Angiotensin-Aldosterone System \[RAAS\]) at nighttime may contribute to the high nocturnal blood pressure in obese individuals which puts them at a higher risk of developing CV events. This current study seeks to determine the biological implications of chronopharmacology for synchronizing NP-RAAS-based blood pressure therapy with the physiological diurnal rhythms to restore the normal diurnal rhythm of blood pressure in obese individuals.
Description
The investigators have demonstrated that there exists a diurnal rhythm of natriuretic peptides (NPs) which tracks closely with the BP rhythm and is in an antiphase relationship with the rhythm of the RAAS (Renin-Angiotensin-Aldosterone System) hormones. The NP levels are lowest at night, and the renin and aldosterone levels are highest at nighttime. Furthermore, the investigators have demonstrated that obese individuals have a putative deficiency of NPs, and this is due to decreased production alongside increased clearance of NPs. LCZ696 is an FDA-approved inhibitor of neprilysin (an NP degrad…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: * Age more than or equal to 18 years of age * Body Mass Index between 30 to 45 kg/m\^2 * Blood pressure: Systolic BP more than or equal to 130mmHg and less than or equal to 160mmHg and diastolic blood pressure more than or equal to 80mmHg and less than or equal to 100mmHg. Individuals with hypertension as per the 2017 ACC/AHA Guidelines will be eligible for enrollment Exclusion Criteria: * Age less than 18, at screening. * Systolic BP \<130 or \>160mmHg at baseline, or diastolic BP \<80 or \>100 mmHg at baseline * BMI \<30 kg/m\^2 or \>45 kg/m\^2 * History of pulmonary h…
Interventions
- DrugSacubitril-Valsartan 49 Mg-51 Mg Oral Tablet
The subject will be randomized, in a double-blind manner to sacubitril/valsartan 49/51 mg once in the morning or once in the evening for a period of 28 days.
- DrugValsartan 80 mg Oral Tablet
The subject will be randomized, in a double-blind manner to valsartan 80 mg once in the morning or once in the evening for a period of 28 days.
Location
- University of Alabama at BirminghamBirmingham, Alabama