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Predictors of daytime blood pressure, nighttime blood pressure, and nocturnal dipping in patients with chronic kidney disease

Hypertension Research volume 47, pages 2511–2520 (2024)Cite this article

A Comment to this article was published on 31 July 2024

Abstract

Increasing attention has recently been paid to discrepancies between office and ambulatory blood pressure (BP) control in patients with chronic kidney disease (CKD), but information on mechanisms underlying circadian BP variations in CKD remains scarce. We described circadian BP patterns and their predictors in patients with CKD stages 1 to 5 referred for kidney function testing in a French tertiary hospital: 1122 ambulatory BP measurements from 635 participants. Factors associated with daytime and nighttime systolic BP (SBP) as well as with nocturnal SBP dipping (ratio of average nighttime to daytime SBP) were analyzed with linear mixed regression models. Participants (mean age 55 ± 16 years; 36% female, mean GFR 51 ± 22 mL/min/1.73m2) had a mean daytime and nighttime SBP of 130 ± 17 and 118 ± 18 mm Hg, respectively. The prevalence of impaired dipping (nighttime over daytime SBP ratio ≥ 0.9) increased from 32% in CKD stage 1 to 68% in CKD stages 4–5. After multivariable adjustment, measured GFR, diabetes, and sub-Saharan African origin were more strongly associated with nighttime than with daytime SBP, which led to significant associations with altered nocturnal BP dipping. For a 1 SD decrease in measured GFR, nighttime BP was 2.87 mmHg (95%CI, 1.44–4.30) higher and nocturnal SBP dipping ratio was 1.55% higher (95%CI, 0.85–2.26%). In conclusion, the prevalence of impaired nocturnal BP dipping increases substantially across the spectrum of CKD. Along with sub-Saharan African origin and diabetes, lower measured GFR was a robust and specific predictor of higher nighttime BP and blunted nocturnal BP decline.

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Author information

Author notes

  1. These authors contributed equally: Emmanuelle Vidal-Petiot, Natalia Alencar de Pinho

Authors and Affiliations

  1. Service de Physiologie et Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 75018, Paris, France

    Justina Motiejunaite, Martin Flamant, Florence Arnoult, Alexandre Lahens, Nahid Tabibzadeh & Emmanuelle Vidal-Petiot

  2. Université Paris Cité, Paris, France

    Justina Motiejunaite, Martin Flamant, Alexandre Lahens, Nahid Tabibzadeh, François Rouzet, François Vrtovsnik & Emmanuelle Vidal-Petiot

  3. Centre for research in Epidemiology and Population Health (CESP), Paris-Saclay University, Inserm U1018, Versailles Saint-Quentin University, Clinical Epidemiology Team, Villejuif, France

    Justina Motiejunaite & Natalia Alencar de Pinho

  4. Center for Research on Inflammation, Université de Paris, Institut National de la Santé et de la Recherche Médicale (INSERM) U1149, F-75018, Paris, France

    Martin Flamant & François Vrtovsnik

  5. Université de Paris, Unité Mixte de Recherche (UMR) S1138, Cordeliers Research Center, 75006, Paris, France

    Nahid Tabibzadeh

  6. Departement de Biochimie, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 75018, Paris, France

    Anne Boutten

  7. Service de Médecine nucléaire, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 75018, Paris, France

    François Rouzet

  8. Université Paris Cité and Université Sorbonne Paris Nord, INSERM, LVTS, F-75018, Paris, France

    François Rouzet & Emmanuelle Vidal-Petiot

  9. Service de Néphrologie, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, 75018, Paris, France

    François Vrtovsnik

Authors
  1. Justina Motiejunaite
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  2. Martin Flamant
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Correspondence to Natalia Alencar de Pinho.

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Motiejunaite, J., Flamant, M., Arnoult, F. et al. Predictors of daytime blood pressure, nighttime blood pressure, and nocturnal dipping in patients with chronic kidney disease. Hypertens Res 47, 2511–2520 (2024). https://doi.org/10.1038/s41440-024-01778-5

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