Tolvaptan improves the diurnal blood pressure profile in patients with hypertension and autosomal-dominant polycystic kidney disease

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is a genetic disorder frequently associated with non-dipper hypertension, with tolvaptan being the only currently approved treatment. However, the effects of tolvaptan on blood pressure (BP) in patients with ADPKD and hypertension remain unclear. METHODS: This retrospective study examined the effect of tolvaptan on 24-hour ambulatory BP monitoring parameters. Changes in ambulatory BP-related parameters, including annual rate of change in total kidney volume (TKV), were assessed in 23 patients with ADPKD and hypertension before and after initiating tolvaptan. RESULTS: After initiation of tolvaptan, nocturnal systolic and diastolic BP dipping rates increased significantly, with systolic dipping rising from 9.61% to 14.0% (Δ + 4.39%; P = .014) and diastolic dipping from 10.48% to 14.66% (Δ + 4.18%; P = .023). The prevalence of a non-dipper BP profile decreased from 57% at baseline to 29% after treatment (P = .0339). In addition, the annual growth rate of TKV decreased from 13.6% to 1.61% (P < .0001), and the eGFR slope improved from -4.46 to - 2.26 mL/min/1.73 m2/year (P = .0431). CONCLUSIONS: Tolvaptan treatment was associated with improvements in nocturnal BP decline and diurnal BP patterns in patients with hypertension and ADPKD. In addition, a reduced rate of TKV growth and a slower decline in eGFR were observed. These findings provide further insight into the potential hemodynamic and renal effects of tolvaptan in this population.