Prognostic Effect of Isolated Nocturnal Hypertension in Chinese Patients With Nondialysis Chronic Kidney Disease

J Am Heart Assoc. 2016 Oct 10;5(10):e004198. doi: 10.1161/JAHA.116.004198.

Abstract

Background: Isolated nocturnal hypertension (INH) has been studied among the general population and hypertensive patients. However, little insight is available on the prognostic effect of INH in patients with chronic kidney disease (CKD). This study investigated the prognostic effect of INH in a cohort of Chinese patients with nondialysis CKD.

Methods and results: A total of 588 Chinese CKD patients who were admitted to the Third Affiliated Hospital of Sun Yat-Sen University were enrolled in this study. We monitored blood pressure (BP) throughout the day and followed health outcomes in the 588 CKD patients admitted to our hospital division. We recorded time to total mortality, cardiovascular mortality, renal events, and cardiovascular events. A total of 370 (62.92%) individuals had nocturnal hypertension, which included 136 (23.13%) patients with INH. Multivariable Cox regression analyses showed that nocturnal BP was a significant risk factor for renal events and cardiovascular events in CKD patients, even when adjusted for clinic BP, 24-hour BP, or daytime BP. Patients with nocturnal hypertension showed a worse prognosis compared with patients with nocturnal normotension (P<0.05), and nocturnal hypertension (versus nocturnal normotension) was associated with an increased risk for renal events (hazard ratio [HR], 3.81; 95% CI, 1.74-8.36) and cardiovascular events (HR, 8.34; 95% CI, 1.98-35.07). In addition, patients with INH had a worse prognosis than patients with normotension (P<0.017), whereas INH (versus normotension) was associated with a higher risk of renal events (HR, 2.78; 95% CI, 1.16-6.65) and cardiovascular events (HR, 6.82; 95% CI, 1.52-30.63).

Conclusions: INH was associated with a poor prognosis in Chinese nondialysis CKD patients.

Keywords: ambulatory blood pressure monitoring; chronic kidney disease; hypertension; isolated nocturnal hypertension; kidney; kidney (diabetes); prognosis.

MeSH terms

  • Adult
  • Arterial Occlusive Diseases / epidemiology
  • Blood Pressure Monitoring, Ambulatory
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / mortality*
  • Cause of Death
  • China / epidemiology
  • Circadian Rhythm
  • Creatinine / blood
  • Disease Progression
  • Female
  • Heart Failure / epidemiology
  • Humans
  • Hypertension / epidemiology*
  • Hypertension / physiopathology
  • Kidney Failure, Chronic / epidemiology*
  • Lower Extremity / blood supply
  • Male
  • Middle Aged
  • Mortality
  • Multivariate Analysis
  • Myocardial Infarction / epidemiology
  • Myocardial Revascularization / statistics & numerical data
  • Peripheral Arterial Disease / epidemiology
  • Prognosis
  • Proportional Hazards Models
  • Renal Insufficiency, Chronic / blood
  • Renal Insufficiency, Chronic / epidemiology*
  • Retinal Artery Occlusion / epidemiology
  • Stroke / epidemiology
  • Young Adult

Substances

  • Creatinine