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Evening home blood pressure and pulse rate: age-specific associations with nocturia severity

Journal of Human Hypertension volume 37, pages 913–918 (2023)Cite this article

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Abstract

Previous studies have reported a significant relationship between hypertension and nocturia. However, the underlying pathophysiology associated with pulse rate (PR) remains unclear. In the Japan Morning Surge-Home Blood Pressure Study, a self-administered nocturia questionnaire and evening home blood pressure (BP) and PR measurements (taken on a mean of 11.2 days) were performed on 4310 patients with one or more cardiovascular risk factors (mean: 64.9 years old; 47% male). According to the number of nighttime voids, the study population was divided into three groups (no voids: n = 2382; 1 void: n = 847; ≥2 voids per night: n = 1082). In the multinomial logistic regression analysis adjusted for confounders, diuretic use (OR, 1.23; 95%CI, 1.01–1.50; p < 0.05) was significantly associated with one nocturnal void, whereas evening home systolic BP (SBP) (OR per 1 SD, 1.14; 95%CI, 1.05–1.24; p < 0.01) and evening home PR (OR per 1 SD, 1.12; 95%CI: 1.02–1.24; p < 0.05) were significantly associated with multiple nocturnal voids. In the younger group (<65 years), only evening home PR was significantly related to multiple nighttime voids (p < 0.01), whereas in the older group (≥65 years), only evening home SBP was significantly related to multiple nighttime voids (p = 0.02). In this study, both higher evening home PR and higher evening home SBP were associated with multiple nighttime voids, with the former playing a greater role in the younger participants, and the latter more often associating the older group. An age-stratified approach to reduce the burden of BP or PR might be important to improve sleep quality.

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Fig. 1: Number of nocturnal voids.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

References

  1. Feldstein CA. Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association. J Am Soc Hypertens. 2013;7:75–84.

    Article  PubMed  Google Scholar 

  2. Tikkinen KA, Johnson TM 2nd, Tammela TL, Sintonen H, Haukka J, Huhtala H, et al. Nocturia frequency, bother, and quality of life: how often is too often? A population-based study in Finland. Eur Urol. 2010;57:488–96.

    Article  PubMed  Google Scholar 

  3. Pesonen JS, Cartwright R, Vernooij RWM, Aoki Y, Agarwal A, Mangera A, et al. The impact of nocturia on mortality: a systematic review and meta-analysis. J Urol. 2020;203:486–95.

    Article  PubMed  Google Scholar 

  4. Weiss JP, Monaghan TF, Epstein MR, Lazar JM. Future considerations in nocturia and nocturnal polyuria. Urology 2019;133S:34–42.

    Article  PubMed  Google Scholar 

  5. Rahman SN, Cao DJ, Monaghan TF, Flores VX, Vaysblat M, Moy MW, et al. Phenotyping the association between nocturia and hypertension: A systematic review and meta-analysis. J Urol. 2021;205:1577–83.

    Article  PubMed  Google Scholar 

  6. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021–104.

    Article  PubMed  Google Scholar 

  7. Nakano Y, Oshima T, Ozono R, Higashi Y, Sasaki S, Matsumoto T, et al. Non-dipper phenomenon in essential hypertension is related to blunted nocturnal rise and fall of sympatho-vagal nervous activity and progress in retinopathy. Auton Neurosci. 2001;88:181–6.

    Article  CAS  PubMed  Google Scholar 

  8. Roy HA, Green AL. The central autonomic network and regulation of bladder function. Front Neurosci. 2019;13:535.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yokoyama O, Nishizawa O, Homma Y, Takeda M, Gotoh M, Kakizaki H, et al. Nocturnal polyuria and hypertension in patients with lifestyle related diseases and overactive bladder. J Urol. 2017;197:423–31.

    Article  PubMed  Google Scholar 

  10. Böhm M, Mahfoud F, Townsend RR, Kandzari DE, Pocock S, Ukena C, et al. Ambulatory heart rate reduction after catheter-based renal denervation in hypertensive patients not receiving anti-hypertensive medications: data from SPYRAL HTN-OFF MED, a randomized, sham-controlled, proof-of-concept trial. Eur Heart J. 2019;40:743–51.

    Article  PubMed  Google Scholar 

  11. Oba Y, Kabutoya T, Hoshide S, Eguchi K, Kario K. Association between nondipper pulse rate and measures of cardiac overload: The J-HOP Study. J Clin Hypertens (Greenwich). 2017;19:402–9.

    Article  CAS  PubMed  Google Scholar 

  12. Hoshide S, Yano Y, Haimoto H, Yamagiwa K, Uchiba K, Nagasaka S, et al. Morning and evening home blood pressure and risks of incident stroke and coronary artery disease in the Japanese general practice population: The Japan Morning Surge-Home Blood Pressure Study. Hypertension 2016;68:54–61.

    Article  CAS  PubMed  Google Scholar 

  13. Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2013;31:1281–357.

    Article  CAS  PubMed  Google Scholar 

  14. Fitzgerald MP, Litman HJ, Link CL, McKinlay JB, BACH Survey Investigators. The association of nocturia with cardiac disease, diabetes, body mass index, age and diuretic use: results from the BACH survey. J Urol. 2007;177:1385–9.

    Article  PubMed  Google Scholar 

  15. Chen HH, Lainchbury JG, Matsuda Y, Harty GJ, Burnett JC Jr. Endogenous natriuretic peptides participate in renal and humoral actions of acute vasopeptidase inhibition in experimental mild heart failure. Hypertension. 2001;38:187–91.

    Article  CAS  PubMed  Google Scholar 

  16. Asplund R. Diuresis pattern, plasma vasopressin and blood pressure in healthy elderly persons with nocturia and nocturnal polyuria. J Med (Neth). 2002;60:276–80.

    CAS  Google Scholar 

  17. Matsumoto T, Tabara Y, Murase K, Setoh K, Kawaguchi T, Nagashima S, et al. Nocturia and increase in nocturnal blood pressure: the Nagahama study. J Hypertens. 2018;36:2185–92.

    Article  CAS  PubMed  Google Scholar 

  18. Manning G, Rushton L, Donnelly R, Millar-Craig MW. Variability of diurnal changes in ambulatory blood pressure and nocturnal dipping status in untreated hypertensive and normotensive subjects. Am J Hypertens. 2000;13:1035–8.

    Article  CAS  PubMed  Google Scholar 

  19. Palatini P. Sympathetic overactivity in hypertension: a risk factor for cardiovascular disease. Curr Hypertens Rep. 2001;3:S3–9.

    Article  PubMed  Google Scholar 

  20. Jouven X, Empana JP, Escolano S, Buyck JF, Tafflet M, Desnos M, et al. Relation of heart rate at rest and long-term (>20 years) death rate in initially healthy middle-aged men. Am J Cardiol. 2009;103:279–83.

    Article  PubMed  Google Scholar 

  21. Pontes RB, Girardi AC, Nishi EE, Campos RR, Bergamaschi CT. Crosstalk between the renal sympathetic nerve and intrarenal angiotensin II modulates proximal tubular sodium reabsorption. Exp Physiol. 2015;100:502–6.

    Article  CAS  PubMed  Google Scholar 

  22. Liu CC, Kuo TB, Yang CC. Effects of estrogen on gender-related autonomic differences in humans. Am J Physiol Heart Circ Physiol. 2003;285:H2188–2193.

    Article  CAS  PubMed  Google Scholar 

  23. Hoshide S, Kario K, Yano Y, Haimoto H, Yamagiwa K, Uchiba K, et al. Association of morning and evening blood pressure at home with asymptomatic organ damage in the J-HOP Study. Am J Hypertens. 2014;27:939–47.

    Article  CAS  PubMed  Google Scholar 

  24. Parati G, Ochoa JE, Lombardi C, Bilo G. Assessment and management of blood-pressure variability. Nat Rev Cardiol. 2013;10:143–55.

    Article  PubMed  Google Scholar 

  25. Selkurt EE. Effect of pulse pressure and mean arterial pressure modification on renal hemodynamics and electrolyte and water excretion. Circulation. 1951;4:541–51.

    Article  CAS  PubMed  Google Scholar 

  26. Shipley RE, Study RS. Changes in renal blood flow, extraction of inulin, glomerular filtration rate, tissue pressure and urine flow with acute alterations of renal artery blood pressure. Am J Physiol. 1951;167:676–88.

    Article  CAS  PubMed  Google Scholar 

  27. Romero JC, Knox FG. Mechanisms underlying pressure-related natriuresis: the role of the renin angiotensin and prostaglandin systems. State of the art lecture. Hypertension. 1988;11:724–38.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We gratefully acknowledge the numerous study investigators, fellows, nurses, and research coordinators at each of the study sites that participated in the J-HOP study. The centers and physicians who participated in this study are presented in the online-only Data Supplement. We also gratefully acknowledge Ms Kimiyo Saito for the coordination and data management of this study, and Ms Ayako Okura for editorial assistance.

Funding

This study was financially supported, in part, by a grant from the 21st Century Center of Excellence Project run by Japan’s Ministry of Education, Culture, Sports, Science and Technology; a grant from the Foundation for Development of the Community (Tochigi); a grant from Omron Healthcare Co., Ltd., a Grant-in-Aid for Scientific Research (B) (21390247) from The Ministry of Education, Culture, Sports, Science and Technology (MEXT) of Japan, 2009–2013; and funds from the MEXT-Supported Program for the Strategic Research Foundation at Private Universities, 2011–2015 Cooperative Basic and Clinical Research on Circadian Medicine (S1101022) to KK. Funding sponsors had no role in the study design or in conducting the study; in the collection, management, analysis, and interpretation of the data; in the preparation of the paper, or in the decision to submit the paper for publication.

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Author notes

  1. These authors contributed equally: Michiaki Nagai, Satoshi Hoshide, Kazuomi Kario.

Authors and Affiliations

  1. Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan

    Michiaki Nagai

  2. Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan

    Satoshi Hoshide & Kazuomi Kario

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  1. Michiaki Nagai
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Contributions

Conceptualization: MN, SH, KK. Project administration: MN. Supervision: SH, KK. Writing—original draft: MN, SH, KK. Writing—review & editing: MN, SH, KK.

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Correspondence to Kazuomi Kario.

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Competing interests

KK reports research grant from A&D, Omron Healthcare, Fukuda Denshi, CureApp, Sanwa Kagaku Kenkyusho, Teijin Pharma, Boehringer Ingelheim Japan, Fukuda Lifetec; consulting fees from A&D, JIMRO, Omron Healthcare, CureApp, Terumo, Fukuda Denshi; honoraria from Otsuka Pharmaceuticals, Omron Healthcare; participation in Advisory Board of Fukuda Denshi; Patent, Fukuda Denshi, outside the submitted work. The other authors report no competing interests.

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Nagai, M., Hoshide, S. & Kario, K. Evening home blood pressure and pulse rate: age-specific associations with nocturia severity. J Hum Hypertens 37, 913–918 (2023). https://doi.org/10.1038/s41371-023-00803-3

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