Abstract 12026: Nocturnal Blood Pressure Burden, Diuretics, and Cardiac Load: Determinants of Nocturia in the Japanese at High-Risk of Cardiovascular Disease

Abstract

Introduction: The majority of epidemiologic studies reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology has not been established. Hypothesis: We hypothesized that nocturnal blood pressure (BP) burden, some classes of antihypertensive agents and cardiac load might be associated with severity of noctria. In this study, the relationships of nocturia with self-measured home BP (HBP), the class of antihypertensive agent, B-type natriuretic peptide (BNP) were investigated in the Japanese at high-risk of cardiovascular disease. Methods: Among 4310 patients with one or more cardiovascular risks recruited for the Japan Morning Surge-Home Blood Pressure Study, the measurements of HBP at morning, evening, and nighttime as well as BNP were performed in the 2785 patients (63.5 years old, male 48.9%). A self-administered questionnaire included items on nocturia was used. Results: According to the number of nocturia (no void: n= 1571; one void: n=557; 2 or more voids per night: n=657), significant associations of systolic BP (SBP) at morning (136 vs 136 vs 140 mmHg, p<0.001), evening (129 vs 129 vs 131 mmHg, p<0.01) and nighttime (120 vs 120 vs 125 mmHg, p<0.001) as well as logBNP (1.15 vs 1.26 vs 1.39, p<0.001) were observed with nocturia severity. In the multinomial logistic regression analysis adjustment for confounders including age, smoking, total cholesterol, fasting blood glucose and HbA1c, the use of diuretics (OR: 1.28, 95%CI: 1.01-1.61, p<0.05) was significantly associated with one nocturnal void, while nighttime SBP (OR: 1.012, 95%CI: 1.01-1.02, p<0.001) and logBNP (1.46, 95%CI: 1.16-1.84, p<0.01) were significantly associated with multiple nocturnal voids. A significant interaction was found between nighttime SBP and logBNP for multiple nocturnal voids (p<0.01). On the other hand, neither morning SBP nor evening SBP had a significant relationship with nocturia. Conclusions: In this study, nighttime SBP and BNP were synergetically associated with severe nocturia in the high-risk Japanese population. Antihypertensive treatment to reduce BP burden during sleep as well as cardiac overload might be important to improve sleep quality caused by nocturia.