Among CKD patients with ambulatory BP at goal, the absence of nocturnal dipping was associated with increased risk of cardiovascular events (HR 2.06; 95% CI 1.15-3.68).
Cohort (n=906)
Yes
Does the absence of nocturnal blood pressure dipping or uncontrolled ambulatory blood pressure increase the risk of cardiovascular events and kidney disease progression in patients with CKD and hypertension?
In patients with CKD, the absence of nocturnal blood pressure dipping is an independent risk factor for cardiovascular events and kidney disease progression, even when overall ambulatory blood pressure is at goal.
Hazard Ratio: 2.06 (95% CI 1.15–3.68)
RATIONALE no nocturnal dipping with ambulatory BP at goal, 20.5%; nocturnal dipping with ambulatory BP above goal, 11.8%; and no nocturnal dipping with ambulatory BP above goal, 49.1%. Among patients with ambulatory BP above goal, the risk of cardiovascular events was greater in the absence (HR, 2.79 95% CI, 1.64-4.75) and presence (HR, 2.05 95% CI, 1.10-3.84) of nocturnal dipping. The same held true for risk of kidney disease progression (HRs of 2.40 95% CI, 1.58-3.65 and 2.11 95% CI, 1.28-3.48 in the absence and presence of nocturnal dipping, respectively). Patients at the ambulatory BP goal but who did not experience nocturnal dipping had an increased risk of the cardiovascular end point (HR, 2.06 95% CI, 1.15-3.68) and the kidney disease progression outcome (HR, 1.82 95% CI, 1.17-2.82). LIMITATIONS: Lack of a diverse cohort (all those enrolled were White). Residual uncontrolled confounding. CONCLUSIONS: Systolic ambulatory BP above goal or the absence of nocturnal dipping, regardless of ambulatory BP, is associated with higher risks of cardiovascular disease and kidney disease progression among patients with CKD. PLAIN-LANGUAGE SUMMARY: Among patients with chronic kidney disease (CKD), ambulatory blood pressure (BP) monitoring improves the identification of individuals at high risk of clinical disease outcomes. Those with uncontrolled ambulatory BP are known to have a higher risk of developing cardiovascular disease and kidney disease progression, particularly when their ambulatory BP does not decline by at least 10% at night. Whether this is also true for patients with presence of optimal ambulatory BP levels but a BP pattern of no nighttime decline is largely unknown. We measured ambulatory BP in 900 Italian patients with CKD and followed them for several years. We found that, independent of ambulatory BP level, the absence of nighttime reductions in BP was associated with worsening of CKD and more frequent cardiovascular events. The absence of nighttime declines in BP is an independent risk factor for adverse events among patients with CKD. Future studies are needed to examine whether treating the absence of nighttime declines in BP improves clinical outcomes.
Borrelli et al. (2022) conducted a cohort in Hypertension and chronic kidney disease (n=906). Absence of nocturnal blood pressure dipping vs. Nocturnal dipping with systolic ambulatory BP at goal was evaluated on Composite of time to initiation of maintenance dialysis or eGFR decline ≥50%, and composite of fatal and nonfatal cardiovascular events (HR 2.06, 95% CI 1.15-3.68). Among CKD patients with ambulatory BP at goal, the absence of nocturnal dipping was associated with increased risk of cardiovascular events (HR 2.06; 95% CI 1.15-3.68).