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Nighttime Masked Uncontrolled Hypertension and Kidney Function
Quick Takes
- Masked uncontrolled hypertension (MUCH), especially nighttime MUCH, was common in patients with nondialysis CKD who also have hypertension, and was associated with LV hypertrophy and the progression of kidney diseases.
- These findings reinforce the importance of ambulatory blood pressure monitoring in the management of nighttime hypertension in patients with CKD.
- These results support current guideline recommendations that nighttime blood pressure control should be an important part of hypertension management.
Study Questions:
What is the prevalence of nighttime masked uncontrolled hypertension (MUCH) and its associations with cardiovascular and kidney outcomes in patients with chronic kidney disease (CKD) who were not receiving dialysis?
Methods:
The investigators conducted a retrospective cohort study of patients with nondialysis CKD and hypertension, enrolled in Shanghai, China, from July 2012–November 2020 and followed up for a median of 39 months. Participants were classified as having controlled hypertension, sustained hypertension, and MUCH, which was further divided into isolated nighttime MUCH and day–night MUCH, assessed by office and ambulatory blood pressure monitoring. Left ventricular hypertrophy (LVH) was determined by echocardiography. The composite kidney outcome consisted of end-stage kidney diseases (ESKDs) and a reduction of estimated glomerular filtration rate (eGFR) by ≥50%. Logistic and Cox regression assessed the associations of hypertension subtypes with LVH and kidney outcomes.
Results:
The 675 patients (425 [63.0%] men; mean [SD] age, 50.8 [15.9] years; mean [SD] eGFR, 61.6 [29.4] mL/min/1.73 m2) included 125 (19.3%) with controlled hypertension, 244 (37.6%) with MUCH, and 280 (43.1%) sustained hypertension. Among patients with MUCH, 2 (0.8%) had isolated daytime MUCH, 154 (63.1%) had isolated nighttime MUCH, and 88 (36.1%) had day–night MUCH. During a median (interquartile range) follow-up of 39 (19-64) months, 130 composite kidney events, including 97 ESKD events, occurred. Compared with controlled hypertension, MUCH and sustained hypertension were associated with LVH (e.g., MUCH: odds ratio [OR], 2.94; 95% CI, 1.18-7.34; p = 0.02) and the composite kidney outcome (e.g., MUCH: hazard ratio [HR], 4.12; 95% CI, 1.75-9.73; p = 0.001) after adjustment for age, sex, proteinuria, eGFR, and other baseline risk factors. Multivariate-adjusted associations were also significant between day–night MUCH and LVH (OR, 3.26; 95% CI, 1.15-9.25) and between isolated nighttime MUCH and the composite kidney outcome (HR, 4.27; 95% CI, 1.69-10.77).
Conclusions:
The authors concluded that nighttime MUCH was common and associated with LVH and poor kidney outcomes among patients with hypertension and nondialysis CKD.
Perspective:
This cohort study suggests that MUCH, especially nighttime MUCH, was common in patients with nondialysis CKD who also have hypertension, and was associated with LVH and the progression of kidney diseases. These findings reinforce the importance of ambulatory blood pressure monitoring in the management of nighttime hypertension in patients with CKD. These results also support current guideline recommendations that nighttime blood pressure control should be an important part of hypertension management, especially in Asia.
Clinical Topics: Heart Failure and Cardiomyopathies, Noninvasive Imaging, Prevention, Acute Heart Failure, Echocardiography/Ultrasound, Hypertension
Keywords: Blood Pressure, Blood Pressure Monitoring, Ambulatory, Diagnostic Imaging, Echocardiography, Glomerular Filtration Rate, Heart Failure, Hypertension, Hypertrophy, Left Ventricular, Kidney Failure, Chronic, Proteinuria, Renal Insufficiency, Chronic, Risk Factors, Secondary Prevention
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