Association between Nocturnal Blood Pressure Dipping and Chronic Kidney Disease among Patients with Controlled Office Blood Pressure

So Mi J. Cho, Hokyou Lee, Tae Hyun Yoo, Jong Hyun Jhee, Sungha Park, Hyeon Chang Kim

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6 Citations (Scopus)


BACKGROUND: Although abnormal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their associations are yet unquantified by nocturnal dipping status. We examined the association of nocturnal BP dipping pattern with albuminuria and kidney function among participants with controlled hypertension without prior advanced kidney disease. METHODS: Ambulatory BP (ABP) measurements were collected from 995 middle-aged, cardiology clinic patients with controlled office BP (OBP) (<140/90 mm Hg). The magnitude of dipping was calculated as the difference between daytime and nighttime systolic BP (SBP) divided by daytime SBP. Accordingly, the participants were categorized as extreme-dipper (≥20%), dipper (10% to <20%), non-dipper (0% to <10%), or reverse-dipper (<0%). We analyzed the cross-sectional associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (<60 ml/min/1.73 m2), adjusting for OBP/ABP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior. RESULTS: The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% extreme-dippers, 43.1% dippers, 34.7% non-dippers, and 8.7% reverse-dippers. In reference to dippers, odds ratios [95% confidence interval] for albuminuria were 1.73 [1.04-2.60] in reverse-dippers, 1.67 [1.20-2.32] in non-dippers, and 0.62 [0.38-1.04] in extreme-dippers. Likewise, abnormal dipping profile was associated with decreased kidney function: reverse-dipping, 2.02 [1.06-3.84]; non-dipping, 1.98 [1.07-3.08]; extreme-dipping, 0.69 [0.20-1.17]. The associations persisted among participants with more conservatively controlled OBP (<130/80 mm Hg). CONCLUSIONS: Monitoring diurnal and nocturnal BP may identify chronic kidney disease otherwise overlooked based on OBP.

Original languageEnglish
Pages (from-to)821-830
Number of pages10
JournalAmerican journal of hypertension
Issue number8
Publication statusPublished - 2021 Aug 1

Bibliographical note

Funding Information:
Te study was supported in part by research grants from the National Key Research and Development Program of China (2017YFC0907200, 2017YFC0907201), the National Natural Science Foundation of China (NSFC 81703220), the Chinese Center of Disease Prevention and Control, and the related collaboration institutions. Tis research used the data collected from the China Health and Nutrition Survey (CHNS). Te National Institute for Nutrition and Health of the China Center for Disease Control and Prevention, Carolina Population Center of the University of North Carolina at Chapel Hill, and the US National Institutes of Health (NIH, R01-HD30880, DK056350, R24 HD050924, R01-HD38700, D43 TW009077, D43 TW007709) provided fnancial support for the CHNS data collection.

Publisher Copyright:
© 2021 American Journal of Hypertension, Ltd 2021. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Internal Medicine


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