title: Both chronic kidney disease and nocturnal blood pressure associate with strokes in the elderly.
abstract: 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).
  
  
  CONCLUSIONS
  In elderly hypertensive patients, both high nocturnal SBP and CKD are independent risk factors for stroke.
authors: American Society of Hypertension Comprehensive Hypertension Center, Department of Medicine, The University of Chicago Medicine, Chicago, IL 60637, USA. yyano@jichi.jp
authors: Yuichiro
authors: Y
authors: Yano
authors: George L
authors: GL
authors: Bakris
authors: Kunihiro
authors: K
authors: Matsushita
authors: Satoshi
authors: S
authors: Hoshide
authors: Kazuyuki
authors: K
authors: Shimada
authors: Kazuomi
authors: K
authors: Kario
mesh_terms: D000368:Aged; D044466:Asian People; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory / Q000379:methods; D002940:Circadian Rhythm; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007564:Japan; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D013997:Time Factors