Prognostic Value of Non-dipping Blood Pressure Patterns in Normotensive and Hypertensive Patients With Chronic Kidney Disease: A Systematic Review

Background: Non-dipping Blood Pressure (BP) patterns, which are highly prevalent among patients with Chronic Kidney Disease (CKD), are independent predictors of cardiovascular risk regardless of average BP levels. However, whether non-dipping independently predicts renal progression beyond overall BP burden remains uncertain. Methods: This review followed PRISMA guidelines across PubMed, Scopus, and Cochrane databases. Cohort studies evaluating non-dipping patterns using ambulatory blood pressure monitoring (ABPM) and renal outcomes in CKD were included. Result: Six cohort studies involving 4,303 patients were included. Across studies, renal outcomes appeared more strongly associated with overall BP control than with dipping status alone. Studies comparing normotensive and hypertensive groups showed that hypertensive dippers and non-dippers experienced faster renal decline and higher ESRD rates. Exploratory pooled data demonstrated that non-dipping with uncontrolled hypertension increased ESRD risk (HR 1.42; 95% CI 1.19-1.69; p < 0.0001). Among controlled patients, non-dippers with on-target BP had lower renal risk than dippers above target. Discussion: The findings suggest that the prognostic significance of non-dipping may depend on overall blood pressure control rather than dipping status alone. Among patients with uncontrolled hypertension, non-dippers appeared to be at greater risk of renal progression than dippers. Conclusion: Among patients with uncontrolled hypertension, non-dippers appeared to be at greater risk of renal progression than dippers. These findings suggest that the prognostic impact of nondipping may be influenced by overall blood pressure control and highlight the importance of achieving adequate 24-hour blood pressure control in patients with CKD.