Both chronic kidney disease and nocturnal blood pressure associate with strokes in the elderly.

Published

Journal Article

BACKGROUND: Among elderly hypertensive patients, we aimed to assess the association of nocturnal blood pressure (BP) pattern on stroke; interaction of dipping pattern with kidney disease was explored. METHODS: We retrospectively analyzed the records of 1,276 elderly (≥60 years) hypertensive Japanese patients (mean 74 years; 40% were men) who had measurements of estimated glomerular filtration rate and ambulatory BP. RESULTS: Stroke events occurred in 73 people over an average of 3.2 years (4,026 person-years). Chronic kidney disease (CKD) at baseline (n = 634, 50%) was more prevalent in people with strokes (71%) than those without strokes (48%; p < 0.01). Both CKD and nocturnal systolic BP (SBP) increase (10 mm Hg) were independently associated with increased risk for stroke [hazard ratio (HR), 1.9; 95% confidence interval (CI), 1.1-3.1 for CKD and HR 1.2; 1.1-1.4 for SBP]. After adjustment for office SBP, a 10-mm Hg increase in nocturnal SBP was similarly associated with strokes in patients with CKD (HR 1.2; 95% CI 1.0-1.3) and those without CKD (HR 1.2; 95% CI 0.97-1.5). Although reverse dipping (nocturnal SBP ≥ daytime SBP) was associated with stroke only in patients with CKD (HR 2.1; 95% CI 1.1-4.1) and not those without CKD (HR 1.1; 95% CI 0.3-3.8), the interaction effect was not significant (p = 0.30). CONCLUSION: In elderly hypertensive patients, both high nocturnal SBP and CKD are independent risk factors for stroke.

Full Text

Duke Authors

Cited Authors

  • Yano, Y; Bakris, GL; Matsushita, K; Hoshide, S; Shimada, K; Kario, K

Published Date

  • January 2013

Published In

Volume / Issue

  • 38 / 3

Start / End Page

  • 195 - 203

PubMed ID

  • 23970169

Pubmed Central ID

  • 23970169

Electronic International Standard Serial Number (EISSN)

  • 1421-9670

International Standard Serial Number (ISSN)

  • 0250-8095

Digital Object Identifier (DOI)

  • 10.1159/000354232

Language

  • eng