Research Paper Volume 11, Issue 13 pp 4310—4322

Nighttime blood pressure decline as a predictor of renal injury in patients with hypertension: a population-based cohort study

Dong Cheng1, , Yi Tang1, , Haiyu Li1, , Yunpeng Li1, , Haiqiang Sang1, ,

  • 1 Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China

Received: January 8, 2019       Accepted: March 10, 2019       Published: July 5, 2019
How to Cite

Copyright: Cheng et al. This is an open‐access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


We explored whether the nighttime blood pressure (BP) decline predicts renal function decline in a population-based cohort with primary hypertension. We measured the baseline ambulatory BP and glomerular filtration rate (GFR) in a cohort of 1,042 primary hypertensive patients. We repeated the GFR measurements and calculated the rate of GFR decline after a median follow-up of 5.8 years. The estimated GFR (eGFR) declined by −0.23 to −0.20 mL/min per year as the nighttime systolic BP (SBP), diastolic BP (DBP), and mean BP decline rates increased by 1% (P < 0.001). In the fully adjusted model, the nighttime SBP, DBP, and mean BP were all related to a steeper rate of eGFR decline by −0.25 to −0.22 mL/min per 1% increase. The adjusted multivariable results indicated that the odds of an eGFR decline were reduced by 46% when the nighttime SBP decline rate increased by 1% (OR= 0.54, 95% CI: 0.46–0.62). The restricted cubic spline model indicated a non-linear dose-response relationship with the nighttime SBP, DBP, and mean BP. Nighttime BP may be an important biomarker of renal function injury in hypertensive patients.


CVD: cardiovascular disease; CKD: chronic kidney disease; CHD: coronary heart disease; ESRD: end stage renal disease; SBP: systolic blood pressure; DBP: diastolic blood pressure; GFR: glomerular filtration rate; LDL-C: low-density lipoprotein; HDL-C: high-density lipoprotein; ALT: alanine aminotransferase; AST: aspartate aminotransferase; ABPM: ambulatory blood pressure monitoring.