Different nocturnal hypertension entities show varying impact on outcomes in CKD
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Nocturnal systolic hypertension conferred a higher likelihood of adverse kidney and cardiovascular outcomes in patients with chronic kidney disease, according to a study that compared different nocturnal hypertension entities.
“Several studies have addressed the association of nocturnal hypertension with target organ damage and adverse outcomes in patients with CKD, indicating the importance of nocturnal BP control for daily practice,” Qin Wang, MD, of Peking University First Hospital in Beijing, and colleagues wrote. “According to achievement of nocturnal BP target(s), four entities exist: nocturnal normotension, isolated nocturnal diastolic hypertension, isolated nocturnal systolic hypertension, and nocturnal systolic-diastolic hypertension. Whether these entities of nocturnal hypertension had different associations with kidney and cardiovascular risks in patients with CKD was not known.”
To investigate, the researchers performed 24-hour ambulatory blood pressure monitoring on 2,024 patients with CKD. Investigators found 73% of patients had some form of nocturnal hypertension. These individuals were categorized as having isolated nocturnal diastolic hypertension (diastolic BP at least 70 mmHg and systolic BP less than 120 mmHg; 26%); isolated nocturnal systolic hypertension (systolic BP at least 120 mm Hg and diastolic BP less than 70 mmHg; 8%); or nocturnal systolic-diastolic hypertension (both systolic BP at least 120 mmHg and diastolic BP at least 70 mmHg; 66%).
Patients were followed for a mean of 4.8 years for kidney events and a mean of 5 years for cardiovascular events.
While no association was observed between isolated nocturnal diastolic hypertension and kidney failure or cardiovascular events, isolated nocturnal systolic hypertension conferred a higher risk for cardiovascular events (hazard ratio = 3.17), while nocturnal systolic-diastolic hypertension showed a higher risk for both kidney failure (HR = 1.71) and cardiovascular outcomes (HR = 2.19).
“Nocturnal systolic hypertension, either alone or in combination with diastolic hypertension, is associated with higher risks for adverse outcomes in patients with CKD,” Wang and colleagues concluded. “Treatment strategies that preferentially have nocturnal systolic BP under control may help to improve prognosis of CKD.”
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