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Multicenter Study
. 2024 Jul 15;37(8):621-630.
doi: 10.1093/ajh/hpae044.

Prognostic Effect of Masked Morning Hypertension in Chinese Inpatients With Non-dialysis Chronic Kidney Disease: A Multicenter Retrospective Study

Lin Lin  1 , Xinying Jiang  1 , Lingling Liu  1 , Jingcan Wu  1 , Tiantian Yu  1 , Yuting Wei  1 , Man Li  2 , Hui Peng  3 , Cheng Wang  1
Affiliations
Multicenter Study

Prognostic Effect of Masked Morning Hypertension in Chinese Inpatients With Non-dialysis Chronic Kidney Disease: A Multicenter Retrospective Study

Lin Lin et al. Am J Hypertens. .

Abstract

Background: This study aimed to elucidate the prognostic role of Masked Morning Hypertension (MMH) in non-dialysis-dependent chronic kidney disease (NDD-CKD).

Methods: 2,130 NDD-CKD patients of the inpatient department were categorized into four blood pressure (BP) groups: clinical normotension (CH-), clinical hypertension (CH+) with morning hypertension (MH+), and without MH+ (MH-) respectively. The correlation between these four BP types and the primary (all-cause mortality) and secondary endpoints (cardio-cerebrovascular disease [CVD] and end-stage kidney disease [ESKD]) was analyzed.

Results: The prevalence of MH and MMH were 47.4% and 14.98%, respectively. Morning hypertension independently increased the risk of all-cause mortality (P = 0.004) and CVD (P < 0.001) but not ESKD (P = 0.092). Masked morning hypertension was associated with heightened all-cause mortality (HR = 4.22, 95% CI = 1.31-13.59; P = 0.02) and CVD events (HR = 5.14, 95% CI = 1.37-19.23; P = 0.02), with no significant association with ESKD (HR = 1.18, 95% CI = 0.65-2.15; P = 0.60). When considering non-CVD deaths as a competing risk factor, a high cumulative incidence of CVD events was observed in the MMH group (HR = 5.16, 95% CI = 1.39-19.08).

Conclusions: MMH is an independent risk factor for all-cause mortality and combined cardiovascular and cerebrovascular events in NDD-CKD patients, underscoring its prognostic significance. This highlights the need for comprehensive management of MH in this population.

Keywords: all-cause mortality; blood pressure; cardio-cerebrovascular disease; chronic kidney disease; end-stage kidney disease; hypertension; masked morning hypertension.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1.
Figure 1.
Flow chart of included patients. ABPM, ambulatory blood pressure monitoring; CKD, chronic kidney disease.
Figure 2.
Figure 2.
Distribution of mortality causes. CH−, clinical normotension; CH+, clinical hypertension; MH+, with morning hypertension; MH−, without morning hypertension.
Figure 3.
Figure 3.
The survival curve between groups with different blood pressure types. CH−, clinical normotension; CH+, clinical hypertension; MH+, with morning hypertension; MH−, without morning hypertension. Survival probability of all-cause mortality (a), CVD(b) and ESKD (c).
Figure 4.
Figure 4.
Competing regression analysis of blood pressure types and endpoint events. (a) Cumulative incidence of CVD events considering non-CVD mortality as a competing risk. (b) Cumulative incidence of renal events considering all-cause mortality as a competing risk. CH−, clinical normotension; CH+, clinical hypertension; MH+, with morning hypertension; MH−, without morning hypertension.
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