Nighttime blood pressure control in hypertensive chinese chronic kidney disease patients

Abstract

Objective To evaluate the nighttime blood pressure(BP) control status of hypertensive Chinese chronic kidney disease (CKD) patients and related risk factors. Methods This cross-sectional study enrolled 337 hypertensive CKD in-patients. The clinical and ambulatory BP monitoring (ABPM) data were retrieved from the electronic database of the hospital. High ambulatory BP were defined as>130/80 mmHg (average 24-hour BP) and>135/85 mmHg (daytime)/>120/70 mmHg (nighttime), respectively. Multivariable analysis was used to evaluate the risk factors for lack of nighttime BP control and circadian rhythm. Results There were 38.6% of the whole population had average 24-hour BP controlled. But only 22.8% of them achieved nighttime BP control, which was far less than the 50.7% of daytime BP control (P<0.01). Even among those patients who achieved average 24-hour BP control shown by ABPM, there were still 44.6% of them with uncontrolled nighttime BP. Multiple analyses showed urinary protein excretion (OR: 1.151, 95%CI: 1.035-1.279) was independent risk factor for lack of nighttime BP control. About 80% of patients presented with non-dipping BP pattern, among whom 37.3% were presented with reverse-dipper pattern. Lack of nighttime BP control was independent risk factor for lack of normal circadian rhythm (both P<0.001). Conclusions Lack of nighttime BP control was common in hypertensive CKD patients and contributed to the abnormal circadian rhythm. ABPM should be performed more commonly in clinical practice to help nighttime BP control in the future. Key words: Kidney disease; Hypertension; Blood pressure monitoring, ambulatory; Nighttime blood pressure