Abstract
Objectives: To determine the association between morning hypertension and target organ damage (TOD) in patients with chronic kidney disease (CKD) and hypertension.Methods: In this cross-sectional study, 447 patients with CKD and hypertension from two centers were enrolled. Ambulatory blood pressure monitoring was conducted in all patients. Linear regression and logistic regression analysis were used to determine the association between morning hypertension and TOD in patients with CKD and hypertension, including assessments of estimated glomerular filtration rate (eGFR), left ventricular mass index (LVMI), urine protein/creatinine ratio (UPCR), and left ventricular hypertrophy (LVH).Results: Overall, 194 (43.4%) participants had morning hypertension. Morning hypertension was strongly correlated with LVH [odds ratio (OR), 2.14; 95% confidence interval (CI), 1.3–3.51; p < 0.01], lower level of eGFR (β = −0.51; 95%CI, −0.95–−0.08; p < 0.05), higher LVMI (β = 0.06; 95%CI, 0.04–0.08, p < 0.001), and UPCR (β = 0.22; 95%CI, 0.06–0.38, p < 0.01), independent of nocturnal hypertension and elevated morning blood pressure surge. As a continuous variable, both morning systolic blood pressure (SBP) and diastolic blood pressure (DBP) were found to be associated with LVH and higher level of UPCR and LVMI (p < 0.05), whereas only morning SBP was negatively correlated with eGFR (p < 0.01).Conclusion: Morning hypertension was strongly correlated with cardiac damage and impaired kidney function in CKD patients with hypertension, independent of nocturnal hypertension and morning surge in blood pressure. Morning hypertension in CKD patients warrants further attention.
Highlights
Hypertension is very common in patients with chronic kidney disease (CKD), with the prevalence of 67–92% [1]; because blood pressure (BP) measured using ambulatory blood pressure monitoring (ABPM) strongly associated cardiovascular (CV) events and renal outcomes, ABPM is considered the preferred metric of BP in both the general population and CKD patients [2]
DBP and estimated glomerular filtration rate (eGFR) was only significant in model 4 (Figure 2, Supplementary Table 4). In this cross-sectional study, we found that the prevalence of morning hypertension in CKD patients was 43.4 and 95.9% of these patients had nocturnal hypertension
Morning hypertension was primarily determined by nighttime BP and morning surge in blood pressure, and nighttime SBP distinguished morning hypertension effectively (AUROC, 0.85; 95%confidence intervals (CIs), 0.81–0.88; p < 0.001)
Summary
Hypertension is very common in patients with chronic kidney disease (CKD), with the prevalence of 67–92% [1]; because blood pressure (BP) measured using ambulatory blood pressure monitoring (ABPM) strongly associated cardiovascular (CV) events and renal outcomes, ABPM is considered the preferred metric of BP in both the general population and CKD patients [2]. It was shown to be associated with target organ damage (TOD) including left ventricular mass index (LVMI), urine albumin/creatinine ratio, maximum carotid intima media thickness [7, 8], and CV events [9, 10] in general or hypertensive patients. It is imperative to investigate the prevalence and role of morning hypertension in CKD patients with TOD, given the high risk of progression to end-stage renal disease and CV damage in these patients
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