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Association Between Nocturnal Blood Pressure Dipping and Chronic Kidney Disease Among Patients With Controlled Office Blood Pressure

Authors
 So Mi J Cho  ;  Hokyou Lee  ;  Tae-Hyun Yoo  ;  Jong Hyun Jhee  ;  Sungha Park  ;  Hyeon Chang Kim 
Citation
 AMERICAN JOURNAL OF HYPERTENSION, Vol.34(8) : 821-830, 2021-08 
Journal Title
AMERICAN JOURNAL OF HYPERTENSION
ISSN
 0895-7061 
Issue Date
2021-08
Keywords
ambulatory blood pressure monitoring ; blood pressure ; chronic kidney disease ; hypertension
Abstract
Background: Although abnormal blood pressure (BP) patterns are associated with adverse cardiorenal outcomes, their associations are yet unquantified by nocturnal dipping status. We examined the association of nocturnal BP dipping pattern with albuminuria and kidney function among participants with controlled hypertension without prior advanced kidney disease.

Methods: Ambulatory BP (ABP) measurements were collected from 995 middle-aged, cardiology clinic patients with controlled office BP (OBP) (<140/90 mm Hg). The magnitude of dipping was calculated as the difference between daytime and nighttime systolic BP (SBP) divided by daytime SBP. Accordingly, the participants were categorized as extreme-dipper (≥20%), dipper (10% to <20%), non-dipper (0% to <10%), or reverse-dipper (<0%). We analyzed the cross-sectional associations of dipping with albuminuria (urine albumin-to-creatinine ratio ≥30 mg/g) and decreased estimated glomerular filtration rate (<60 ml/min/1.73 m2), adjusting for OBP/ABP, antihypertensive class, body mass index, total cholesterol, fasting glucose, socioeconomic status, and health behavior.

Results: The participants (mean age 60.2 years; 52.9% male) consisted of 13.5% extreme-dippers, 43.1% dippers, 34.7% non-dippers, and 8.7% reverse-dippers. In reference to dippers, odds ratios [95% confidence interval] for albuminuria were 1.73 [1.04-2.60] in reverse-dippers, 1.67 [1.20-2.32] in non-dippers, and 0.62 [0.38-1.04] in extreme-dippers. Likewise, abnormal dipping profile was associated with decreased kidney function: reverse-dipping, 2.02 [1.06-3.84]; non-dipping, 1.98 [1.07-3.08]; extreme-dipping, 0.69 [0.20-1.17]. The associations persisted among participants with more conservatively controlled OBP (<130/80 mm Hg).

Conclusions: Monitoring diurnal and nocturnal BP may identify chronic kidney disease otherwise overlooked based on OBP.
Full Text
https://academic.oup.com/ajh/article/34/8/821/6131445
DOI
10.1093/ajh/hpab031
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Yoo, Tae Hyun(유태현) ORCID logo https://orcid.org/0000-0002-9183-4507
Lee, Hokyou(이호규) ORCID logo https://orcid.org/0000-0002-5034-8422
Jhee, Jong Hyun(지종현)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/186988
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