Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years

Abstract

Background Hypertension is assumed to be asymptomatic. Yet, clinically significant nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to nocturia because of blunted nocturnal blood pressure ( BP ) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to nocturia. Here, we test the hypothesis that nocturia is a common and potentially reversible symptom of uncontrolled hypertension in black men. Methods and Results We determined the strength of association between nocturia (≥2 nightly voids) and high BP (≥135/85 mm Hg) by conducting in‐person health interviews and measuring BP with an automated monitor in a large community‐based sample of black men in their barbershops. Because nocturia is prevalent and steeply age‐dependent after age 50 years, we studied men aged 35 to 49 years. Among 1673 black men (mean age, 43±4 years [ SD ]), those with hypertension were 56% more likely than men with normotension to have nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95% CI , 1.25–1.94 [ P <0.0001]). Nocturia prevalence varied by hypertension status, ranging from 24% in men with normotension to 49% in men whose hypertension was medically treated but uncontrolled. Men with untreated hypertension were 39% more likely than men with normotension to report nocturia ( P =0.02), whereas men whose hypertension was treated and controlled were no more likely than men with normotension to report nocturia ( P =0.69). Conclusions Uncontrolled hypertension was an independent determinant of clinically important nocturia in a large cross‐sectional community‐based study of non‐Hispanic black men aged 35 to 49 years. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unqiue identifier: NCT 02321618.

Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

“…The present analysis is consistent with and extends upon previous literature reporting an inverse correlation between the number of nocturnal voids and the severity of hypertension 3–5 . The most likely explanation for the observed associations is that LVH and LAE are indicative of cardiac structural and possibly vascular changes, which predispose to sodium and water retention.…”

“…Despite these limitations and the preliminary nature of the present results, the strength of the observed associations was quite large, underscoring the existence of a robust association between nocturia and ECG abnormalities. Nocturia is often overlooked by cardiologists, but has recently been shown to have value in identifying undiagnosed and poorly controlled hypertension in young African‐American males 4 . The present study findings would suggest that a history of nocturia provides an additional opportunity to identify a subset of patients more likely to have ECG abnormalities and therefore a higher cardiovascular risk.…”

“…Also, nocturia has been found to be associated with subclinical markers of vascular disease such as endothelial dysfunction and increased arterial stiffness, 20 which, in turn, are often associated with cardiac structural abnormalities 21,22 . In addition, nocturia is well known to accompany volume overload states that occur in the setting of congestive heart failure and poorly controlled hypertension 4,23 . The relation between volume overload and nocturia has been supported by recent studies showing salutary effects of both sodium restriction and loop diuretics on the frequency and severity of nocturia 24,25 .…”

“…Nocturia is among the most common lower urinary tract symptoms in the general population 1 . Although classically considered a urological condition, nocturia has been increasingly recognized as a manifestation of systemic disease, and multiple studies have shown the presence and severity of nocturia to be associated with hypertension 2–5 . Pathophysiologic mechanisms underlying this association have not been fully characterized, but may involve nocturnal polyuria owing to dysregulation of the renin‐angiotensin‐aldosterone axis and a corresponding increase in nocturnal natriuresis, 6 as well as diminished functional bladder capacity from chronic vascular insufficiency mediated by hypertension and other atherosclerotic risk factors 7–9 .…”

Sodium restriction improves nocturia in patients at a cardiology clinic

“…While hypertension is the most common risk factor for congestive heart failure, it is notable that multiple studies have reported an association between nocturia and hypertension . Victor et al reported nocturia to be an important clinical clue of undiagnosed or uncontrolled hypertension in young black males . In the present study, the lack of significant change in blood pressure with sodium restriction is consistent with the results of a prior meta‐analysis .…”