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2016 ; 67
(5
): 1029-37
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Glucocorticoids Induce Nondipping Blood Pressure by Activating the
Thiazide-Sensitive Cotransporter
#MMPMID26953322
Ivy JR
; Oosthuyzen W
; Peltz TS
; Howarth AR
; Hunter RW
; Dhaun N
; Al-Dujaili EA
; Webb DJ
; Dear JW
; Flatman PW
; Bailey MA
Hypertension
2016[May]; 67
(5
): 1029-37
PMID26953322
show ga
Blood pressure (BP) normally dips during sleep, and nondipping increases
cardiovascular risk. Hydrochlorothiazide restores the dipping BP profile in
nondipping patients, suggesting that the NaCl cotransporter, NCC, is an important
determinant of daily BP variation. NCC activity in cells is regulated by the
circadian transcription factor per1. In vivo, circadian genes are entrained via
the hypothalamic-pituitary-adrenal axis. Here, we test whether abnormalities in
the day:night variation of circulating glucocorticoid influence NCC activity and
BP control. C57BL6/J mice were culled at the peak (1:00 AM) and trough (1:00 PM)
of BP. We found no day:night variation in NCC mRNA or protein but NCC
phosphorylation on threonine(53) (pNCC), required for NCC activation, was higher
when mice were awake, as was excretion of NCC in urinary exosomes. Peak NCC
activity correlated with peak expression of per2 and bmal1 (clock genes) and sgk1
and tsc22d3 (glucocorticoid-responsive kinases). Adrenalectomy reduced NCC
abundance and blunted the daily variation in pNCC levels without affecting
variation in clock gene transcription. Chronic corticosterone infusion increased
bmal1, per1, sgk1, and tsc22d3 expression during the inactive phase. Inactive
phase pNCC was also elevated by corticosterone, and a nondipping BP profile was
induced. Hydrochlorothiazide restored rhythmicity of BP in corticosterone-treated
mice without affecting BP in controls. Glucocorticoids influence the day:night
variation in NCC activity via kinases that control phosphorylation. Abnormal
glucocorticoid rhythms impair NCC and induce nondipping. Night-time dosing of
thiazides may be particularly beneficial in patients with modest glucocorticoid
excess.