Nighttime Masked Uncontrolled Hypertension and Kidney Functi
A retrospective cohort study of patients with nondialysis CKD and hypertension, enrolled in Shanghai, China, from July 2012–November 2020 and followed up for a median of 39 months. Participants were classified as having controlled hypertension, sustained hypertension, and nighttime masked uncontrolled hypertension (MUCH), which was further divided into isolated nighttime MUCH and day–night MUCH, assessed by office and ambulatory blood pressure monitoring. Left ventricular hypertrophy (LVH) was determined by echocardiography. The composite kidney outcome consisted of end-stage kidney diseases (ESKDs) and a reduction of estimated glomerular filtration rate (eGFR) by 50%. Logistic and Cox regression assessed the associations of hypertension subtypes with LVH and kidney outcomes.

The 675 patients (425 [63.0%] men; mean [SD] age, 50.8 [15.9] years; mean [SD] eGFR, 61.6 [29.4] mL/min/1.73 m2) included 125 (19.3%) with controlled hypertension, 244 (37.6%) with MUCH, and 280 (43.1%) sustained hypertension. Among patients with MUCH, 2 (0.8%) had isolated daytime MUCH, 154 (63.1%) had isolated nighttime MUCH, and 88 (36.1%) had day–night MUCH. During a median (interquartile range) follow-up of 39 (19-64) months, 130 composite kidney events, including 97 ESKD events, occurred. Compared with controlled hypertension, MUCH and sustained hypertension were associated with LVH (e.g., MUCH: odds ratio [OR], 2.94; 95% CI, 1.18-7.34; p=0.02) and the composite kidney outcome (e.g., MUCH: hazard ratio [HR], 4.12; 95% CI, 1.75-9.73; p=0.001) after adjustment for age, sex, proteinuria, eGFR, and other baseline risk factors. Multivariate-adjusted associations were also significant between day–night MUCH and LVH (OR, 3.26; 95% CI, 1.15-9.25) and between isolated nighttime MUCH and the composite kidney outcome (HR, 4.27; 95% CI, 1.69-10.77). The authors concluded that nighttime MUCH was common and associated with LVH and poor kidney outcomes among patients with hypertension and nondialysis CKD.