Nocturnal polyuria (NP), the most common etiology of nocturia, can be caused by various medical conditions, including cardiovascular disease, obstructive sleep apnea, renal tubular dysfunction, as well as medications (e. g. diuretics) and/or behavioral patterns. NP in the absence of underlying medical conditions has been described as nocturnal polyuria syndrome (NPS) and is thought be the result of impaired circadian release of endogenous arginine vasopressin (AVP). Desmopressin, a synthetic AVP analog, has been shown to be an effective replacement therapy in adults with nocturia due to NP. Further studies on the subset of patients with NPS are warranted to maximize benefit from antidiuretic treatment. In addition, a connection between the pathophysiological mechanisms underlying NP and essential hypertension has been suggested, and hypertension has been shown to be a significant risk factor for nocturia, while an association between NP and brain natriuretic peptide levels has also been reported in patients with nocturia. Hypertension is now viewed as a disorder of blood vessels and treatment is directed at the vasculature rather than the blood pressure, with the latter currently serving as a biomarker for arterial injury. Nocturia is thought to be associated with the beginning of this cardiovascular continuum as studies have reported a link between coronary heart disease and nocturia. Therefore, there is an increasing need to elucidate the complex mechanisms implicated in the association between nocturia and hypertension to promote the development of more individualized therapies for the treatment of nocturia.
Urology. 2019 Jun 21 [Epub ahead of print]
Jeffrey P Weiss, Thomas F Monaghan, Matthew R Epstein, Jason M Lazar
Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA. Electronic address: ., Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA. Electronic address: ., Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY, USA. Electronic address: ., Department of Medicine, Division of Cardiovascular Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. Electronic address: .