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

Wang, Cheng; Li, Yan; Zhang, Jun; Ye, Zengchun; Zhang, Qunzi; Ma, Xinxin; Peng, Hui; Lou, Tanqi

doi:10.1161/jaha.116.004198

Cited by 31 publications

(28 citation statements)

References 26 publications

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“…Kario et al showed that nocturnal systolic BP, measured by home BP monitoring, was associated with urinary albumin/creatinine ratio, LV mass index, brachial-ankle 42 Presta et al showed that patients with masked hypertension and reverse BP pattern had a significantly higher risk of stroke, even after adjustment for age, gender, BMI, dyslipidemia, and diabetes. 43 Even though reverse dipping pattern does not always mean nocturnal hypertension, in this study the patients with reverse dipping also had nocturnal hypertension.…”

Section: Target Organ Damagementioning

confidence: 99%

<p>Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?</p>

Tadić¹,

Cuspidi²,

Mancia³

2020

IBPC

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Nocturnal hypertension has been recognized as a significant risk factor for cardioand cerebrovascular diseases. Blood pressure (BP) monitoring significantly increased our awareness of nocturnal hypertension and studies revealed its influence on target organ damage. Nocturnal hypertension is associated with nonphysiological 24-h BP patterns, which consider inadequate drop or even increment of nighttime BP in comparison with daytime BP (nondipping and reverse dipping). Nevertheless, investigations showed that nocturnal hypertension was a predictor of adverse outcome independently of circadian BP pattern. There are still many uncertainties regarding diagnosis, mechanisms and treatment of nocturnal hypertension. There is a small difference between American and European guidelines in cutoff values defining nocturnal hypertension. Pathophysiology is also not clear because many conditions such as diabetes, metabolic syndrome, obesity, sleep apnea syndrome, and renal diseases are related to nocturnal hypertension and nonphysiological circadian BP pattern, but mechanisms of nocturnal hypertension still remain speculative. Therapeutic approach is another important issue and chronotherapy provided the best results so far. There are studies which showed that some groups of antihypertensive medications are more effective in regulation of nocturnal BP, but it seems that the timing of drug administration has a crucial role in the reduction of nighttime BP and conversion of circadian patterns from nonphysiologic to physiologic. Follow-up studies are necessary to define clinical benefits of nocturnal BP reduction and restoring unfavorable 24-h BP variations to physiological variant.

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Section: Target Organ Damagementioning

confidence: 99%

<p>Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?</p>

Tadić¹,

Cuspidi²,

Mancia³

2020

IBPC

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“…The cuff was matched to the perimeter of the arm, and measurements of BP and PR were performed every 15 minutes in the daytime and every 30 minutes at night. Patients underwent 24‐hour ABPM using the TM‐2430 Monitor as previously reported . Before beginning ABPM, BP was measured according to standardized protocols, which has also been reported previously .…”

Section: Methodsmentioning

confidence: 99%

“…Patients underwent 24‐hour ABPM using the TM‐2430 Monitor as previously reported . Before beginning ABPM, BP was measured according to standardized protocols, which has also been reported previously . All patients underwent standard supine 12‐lead electrocardiogram detection after the individual had rested in the supine position for 5 minutes.…”

Section: Methodsmentioning

confidence: 99%

Nocturnal pulse rate correlated with ambulatory blood pressure and target organ damage in patients with chronic kidney disease

Zhang

Wen

Yin

et al. 2018

J of Clinical Hypertension

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The relationship between resting pulse rate (PR) and the occurrence of hypertension and cardiovascular (CV) mortality has been described in the general population. Few studies have examined the relationship between ambulatory PR, ambulatory blood pressure (BP), and target organ damage (TOD) in patients with chronic kidney disease (CKD). A total of 1509 patients with CKD were recruited in our hospital. Ambulatory blood pressure monitoring (ABPM) over a 24‐hours period was performed and referenced with clinical data in this cross‐sectional study. TOD was measured by estimated glomerular filtration rate (eGFR), left ventricular hypertrophy (LVH), and carotid intima‐media thickness (cIMT). Univariate and multivariate analyses were used to evaluate the relationship between PR, BP, and TOD. The percentage of male patients was 58.3% with a mean age of 44.6 ± 16.2 years. Nocturnal PR rather than 24‐hours PR or daytime PR was an independent risk factor for clinical hypertension, 24‐hours hypertension, BP dipper state, poor renal function, and LVH. In addition, the authors found that nighttime PR >74 beats/min (bpm) group was independently associated with clinical hypertension, 24‐hours hypertension, day and night hypertension, nondipping BP, lower eGFR, and LVH when compared with nighttime PR <64 bpm group. Furthermore, 1:1 propensity score matching between PR ≤74 bpm group and PR >74 bpm group was performed. Multivariate analyses indicated nighttime PR >74 bpm remained independently associated with clinical hypertension, daytime and nighttime hypertension, and LVH. An increased nocturnal PR is associated with TOD, higher BP, and nondipping BP in patients with CKD.

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“…Ambulatory blood pressure monitoring (ABPM) could provide detailed information on BP over a 24h period, and it is unanimously recommended by guidelines for BP management 5-6[ii] 7 . Previously, we have reported the high prevalence and prognostic value of nighttime hypertension in CKD patients compared with clinic blood pressure [8][9] [iii] 10 . Recent evidence from large-scale cohort study also suggests that higher 24-hour and nighttime blood pressure measurements were signi cantly associated with greater risks of death and cardiovascular disease, even after adjusting for other o ce-based or ambulatory blood pressure measurements 11 .…”

Section: Introductionmentioning

confidence: 99%

Ambulatory blood pressure is better associated with target organ damage than clinic blood pressure in patients with primary glomerular disease

Wen

chen

Zhu

et al. 2020

Preprint

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Background: Blood pressure is an important and modifiable cardiovascular risk factor. Ambulatory blood pressure monitoring (ABPM) provides valuable prognostic information in patients with chronic kidney disease (CKD), yet little is known about the association of various types of BP measurements with target organ damage (TOD) in patients with primary glomerular disease. The goal of this study was to investigate whether ambulatory blood pressure is better associated with TOD than clinic blood pressure in patients with primary glomerular disease. Methods: 1178 patients with primary glomerular disease were recruited in this cross-sectional study. TOD were assessed by the following 4 parameters: left ventricular mass index (LVMI or LVH, left ventricular hypertrophy), estimated glomerular filtration rate (eGFR<60ml/min/1.73m 2 ), albumin-to-creatinine ratio (ACR≥30mg/g) and carotid intima-media thickness (cIMT) or plaque. Receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to evaluate the relationship between ambulatory or clinic systolic blood pressure (SBP) indexes and TOD. Results: Among 1178 patients (mean age, 39 years,54% men), 116, 458, 1031 and 251 patients had LVH, eGFR < 60 ml/min/1.73m 2 , ACR≥30mg/g and cIMT≥0.9mm or plaque respectively. Area under ROC curves for TOD in ambulatory SBP, especially nighttime SBP, was greater than that in clinic SBP ( P <0.05). Multivariate logistic regression analyses showed that 24h SBP, daytime SBP and nighttime SBP were significantly associated with LVH, eGFR<60 ml/min/1.73m 2 and ACR≥30mg/g after adjustment for clinic SBP, while the association of clinic SBP was attenuated after further adjustment for nighttime SBP. Conclusions: Ambulatory blood pressure, especially nighttime blood pressure, is probably superior to clinic blood pressure in predicting TOD in patients with primary glomerular disease.

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

Cited by 31 publications

References 26 publications

<p>Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?</p>

<p>Isolated Nocturnal Hypertension: What Do We Know and What Can We Do?</p>

Nocturnal pulse rate correlated with ambulatory blood pressure and target organ damage in patients with chronic kidney disease

Ambulatory blood pressure is better associated with target organ damage than clinic blood pressure in patients with primary glomerular disease

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