title: Night-time blood pressure is associated with the development of chronic kidney disease in a general population: the Ohasama Study.
abstract: OBJECTIVE
  Ambulatory blood pressure (BP) is reportedly associated with target organ damage. However, whether ambulatory BP carries prognostic significance for the development of chronic kidney disease (CKD) has not been confirmed.
  
  
  METHODS
  We measured ambulatory BP in 843 participants without CKD at baseline from a general Japanese population and examined the incidence of CKD defined as positive proteinuria or an estimated glomerular filtration rate (eGFR) less than 60 ml/min per 1.73 m at health checks. The association between baseline ambulatory BP and CKD incidence was examined using the Cox proportional hazard regression model adjusted for sex, age, BMI, habitual smoking, habitual alcohol consumption, diabetes mellitus, hypercholesterolemia, a history of cardiovascular disease, antihypertensive medication, eGFR at baseline, the number of follow-up examinations, and the year of the baseline examination.
  
  
  RESULTS
  The mean age of the participants averaged 62.9 ± 8.1 years, 71.3% were women and 23.7% were under antihypertensive medication. During a median follow-up of 8.3 years, 220 participants developed CKD events. The adjusted hazard ratios for CKD in a 1-standard deviation increase in daytime and night-time SBP were 1.13 [95% confidence interval (CI) 0.97-1.30] and 1.21 (95% CI 1.04-1.39), respectively. When night-time and daytime BP was mutually adjusted into the same model, only night-time BP persisted as an independent predictor of CKD.
  
  
  CONCLUSIONS
  Night-time BP is a better predictor of CKD development than daytime BP in the general population. Ambulatory BP measurement is considered useful for evaluating the risk of progression to CKD.
authors.affiliation: aDepartment of Nephrology, Sendai Shakai Hoken Hospital bPlanning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences cDepartment of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan dDepartment of Cardiovascular Diseases, Studies Coordinating Center, Division of Hypertension and Cardiovascular Rehabilitation, University of Leuven, Leuven, Belgium eMedical Information Technology Center, Tohoku University Hospital, Sendai fOhasama Hospital, Hanamaki gDepartment of Social Welfare, Faculty of Synthetic Welfare, Tohoku Fukushi University hDepartment of Clinical Pharmacology and Therapeutics, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai iDepartment of Hygiene and Public health, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Atsuhiro
authors.initials: A
authors.lastname: Kanno
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kikuya
authors.forename: Kei
authors.initials: K
authors.lastname: Asayama
authors.forename: Michihiro
authors.initials: M
authors.lastname: Satoh
authors.forename: Ryusuke
authors.initials: R
authors.lastname: Inoue
authors.forename: Miki
authors.initials: M
authors.lastname: Hosaka
authors.forename: Hirohito
authors.initials: H
authors.lastname: Metoki
authors.forename: Taku
authors.initials: T
authors.lastname: Obara
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Hoshi
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Totsune
authors.forename: Toshinobu
authors.initials: T
authors.lastname: Sato
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Taguma
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sato
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Imai
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ohkubo
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002940:Circadian Rhythm; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged