Key result
Higher night-time systolic blood pressure was superior to daytime systolic blood pressure for predicting adverse renal outcomes, with every 10-mmHg increase associated with a 15% increased risk of ESRD or death (HR 1.15).
Why the study?
Does night-time systolic blood pressure predict composite renal outcomes better than daytime systolic blood pressure in patients with chronic kidney disease?
Observational (n=421)
No
Does night-time systolic blood pressure predict composite renal outcomes better than daytime systolic blood pressure in patients with chronic kidney disease?
Hazard Ratio: 1.15 (95% CI 1.05–1.27)
p-value: p=<0.01
Night-time systolic blood pressure is a superior predictor of adverse renal outcomes (ESRD or death) compared to daytime systolic blood pressure in patients with chronic kidney disease.
Night-time SBP may refine renal risk stratification beyond daytime values in CKD; leaves open whether targeting it improves outcomes.
BACKGROUND: Differences in the predictive value of daytime systolic blood pressure (SBP) and night-time SBP by ambulatory blood pressure monitoring on renal outcomes have not been fully investigated in chronic kidney disease (CKD) patients. This study compared the prognostic value between daytime and night-time SBP on renal outcomes in CKD. METHODS AND RESULTS: This prospective observational study included 421 patients. The composite renal endpoint was endstage renal disease (ESRD) or death. Cox models were used to determine associations of daytime and night-time SBP with renal outcomes. There were 150 renal events (ESRD, 130; death, 20). Multivariable Cox analyses demonstrated that hazard ratios (HRs) [95% confidence interval (CI)] for composite renal outcomes of every 10-mmHg increase in daytime and night-time SBP levels were 1.13 (1.02-1.26) (P=0.02) and 1.15 (1.05-1.27) (P<0.01), respectively. In addition, compared with the 1st daytime or night-time SBP quartile, HRs (95% CI) for outcomes in the 2nd, 3rd, and 4th quartiles were: daytime SBP, 1.25 (0.70-2.25), 1.09 (0.61-1.94), and 1.58 (0.88-2.85; P=0.13) (P for trend=0.16); night-time SBP, 1.09 (0.61-1.96), 1.31 (0.76-2.28), and 1.82 (1.00-3.30; P=0.049) (P for trend=0.03), respectively. CONCLUSIONS: Night-time SBP appeared superior to daytime SBP for predicting renal outcomes in this population of patients.
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Katafuchi et al. (2017) conducted an observational in Chronic Kidney Disease (n=421). Night-time systolic blood pressure vs. Daytime systolic blood pressure / lower night-time SBP was evaluated on Composite of endstage renal disease (ESRD) or death (HR 1.15, 95% CI 1.05-1.27, p=<0.01). Higher night-time systolic blood pressure was superior to daytime systolic blood pressure for predicting adverse renal outcomes, with every 10-mmHg increase associated with a 15% increased risk of ESRD or death (HR 1.15).
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