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Nocturnal systolic blood pressure dipping and progression of chronic kidney disease

Hypertension Research volume 47, pages 215–224 (2024)Cite this article

Abstract

The relationship between declining nocturnal blood pressure (BP) and adverse cardiovascular outcomes is well-recognized. However, the relationship between diurnal BP profile and the risk of chronic kidney disease (CKD) progression is unclear. Herein, we examined the association between nocturnal systolic SBP (SBP) dipping and CKD progression in 1061 participants at the Cardiovascular and Metabolic Disease Etiology Research Center-High Risk (CMERC-HI). The main exposure was diurnal systolic BP (SBP) profile and diurnal SBP difference ([nighttime SBP-daytime SBP] × 100/daytime SBP). The primary outcome was CKD progression, defined as a composite of ≥ a 50% decline in the estimated glomerular filtration rate from baseline or the initiation of kidney replacement therapy. During 4749 person-years of follow-up (median, 4.8 years), the composite outcome occurred in 380 (35.8%) participants. Compared to dippers, the hazard ratios (HRs) for the risk of adverse kidney outcomes were 1.02 (95% confidence interval [CI], 0.64–1.62), 1.30 (95% CI, 1.02–1.66), and 1.40 (95% CI, 1.03–1.90) for extreme dipper, non-dipper, and reverse dipper, respectively. In a continuous modeling, a 10% increase in diurnal SBP difference was associated with a 1.21-fold (95% CI, 1.07–1.37) higher risk of CKD progression. Thus, decreased nocturnal SBP decline was associated with adverse kidney outcomes in patients with CKD. Particularly, patients with non-dipping and reverse dipping patterns were at higher risk for CKD progression than those with a dipping pattern.

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Funding

This research was supported by the “National Institute of Health” research project (project No. 2021-ER0903-02; SP) and a grant from the Korean Health Technology Research and Development Project through the Korean Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant number HI13C0715; SP) and by a research program funded by the Korea Disease Control and Prevention Agency (grant number 2021-ER0903-02; SP). This research was also supported by the Main Research Program (grant number E0210601-03; SP) of the Korea Food Research Institute, funded by the Korean Ministry of Science and ICT. The funders of this study had no role in study design, data collection, analysis, reporting, or the decision to submit for publication.

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Author notes

  1. These authors contributed equally: Sungha Park, Tae-Hyun Yoo

Authors and Affiliations

  1. Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea

    Cheol Ho Park, Seung Hyeok Han, Shin-Wook Kang & Tae-Hyun Yoo

  2. Division of Nephrology, Department of Internal Medicine, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea

    Jong Hyun Jhee

  3. Department of Internal Medicine, National Health Insurance Service Medical Center, Ilsan Hospital, Goyang, Republic of Korea

    Kyeong-Hyeon Chun

  4. Division of Cardiology, Department of Internal Medicine, College of Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, Republic of Korea

    Jiwon Seo

  5. Division of Cardiology, Severance Cardiovascular Hospital, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea

    Chan Joo Lee & Sungha Park

  6. Food Functionality Research Division, Korea Food Research Institute, Wanju, Republic of Korea

    Soo-Hyun Park & Jin-Taek Hwang

  7. Department of Food Biotechnology, University of Science and Technology, Daejeon, Republic of Korea

    Jin-Taek Hwang

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Correspondence to Sungha Park or Tae-Hyun Yoo.

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Park, C.H., Jhee, J.H., Chun, KH. et al. Nocturnal systolic blood pressure dipping and progression of chronic kidney disease. Hypertens Res 47, 215–224 (2024). https://doi.org/10.1038/s41440-023-01368-x

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