Nighttime central blood pressure and left ventricular hypertrophy in non-dialysis chronic kidney disease: a multicenter study.

BACKGROUND

Nocturnal hypertension is closely associated with left ventricular hypertrophy (LVH) in patients with chronic kidney disease (CKD). Recently, several studies have shown that central pressure reflects the actual load on the cardiovascular system. However, the relationship between nighttime central systolic blood pressure (SBP) and LVH in CKD patients remains unknown.

METHODS

A total of 3198 non-dialysis CKD patients were enrolled in this multicenter retrospective study. Ambulatory blood pressure monitoring was performed using the Mobil-O-Graph PWA device. Applying 120/130 mm Hg as the nighttime brachial SBP (bSBP)/central SBP with c2 calibration (c2SBP) thresholds, patients were classified into 4 nocturnal hypertension patterns. Logistic regression and the net reclassification improvement were used to analyze the associations between nocturnal SBP indices and LVH.

RESULTS

There were 989 patients (30.9%) who had nocturnal central hypertension, and 448 patients (15%) had LVH. As renal function declined, the incidence of both LVH and nocturnal hypertension demonstrated a significant ascending trend. In addition, LVH risk increased progressively with higher nighttime c2SBP levels. Multivariate logistic regression and net reclassification improvement analyses suggested that nighttime c2SBP demonstrated superior correlation with LVH compared to nighttime bSBP. With consistent nocturnal normotension as the reference, the adjusted odds ratios were 1.183 (95% CI: 0.816-1.715, P = .377) for isolated nocturnal brachial hypertension and 2.660 (95% CI: 2.051-3.449, P < .001) for consistent nocturnal hypertension, respectively.

CONCLUSIONS

Nighttime central SBP is more closely associated with LVH in non-dialysis CKD patients, and further prospective studies are needed to validate its prognostic value.