title: Morning hypertension and night non-dipping in patients with diabetes and chronic kidney disease.
abstract: Morning hypertension (HTN) and nocturnal non-dipping (ND) are closely associated with target organ damage and cardiovascular events. However, their importance in diabetics with advanced renal disease is unclear. We evaluated the relationships of morning HTN and ND with estimated glomerular filtration rate (eGFR) and proteinuria, and determined the risk of morning HTN and ND according to presence of diabetes mellitus (DM) and chronic kidney disease (CKD) stage. A total of 1312 patients, including 439 with diabetes, were prospectively recruited at 21 centers in Korea. All patients had HTN and an eGFR of 15-89 ml min(-1) per 1.73 m(2). Ambulatory 24-h blood pressure was assessed. The rates of morning HTN (25.2% vs. 13.6%, P<0.001) and ND (58.2% vs. 48.2%, P=0.002) were higher in diabetics than in non-diabetics. eGFR was correlated with ND in all patients (P<0.05) and with morning HTN only in non-diabetics (P=0.005). Proteinuria was related to ND in all patients (P<0.05) and to morning HTN only in diabetics (P=0.001). In a regression analysis, the risk of morning HTN was 2.093 (95% confidence interval (95% CI): 1.070-4.094) for the DMCKD2 group, 1.634 (95% CI: 1.044-2.557) for the CKD3-4-only group and 2.236 (95% CI: 1.401-3.570) for the DMCKD3-4 group compared with the CKD2-only group. The risk of ND was high for stage 3-4 CKD: 1.581 (95% CI: 1.180-2.120) for non-diabetics and 1.842 (95% CI: 1.348-2.601) for diabetics. Diabetics showed higher rates of morning HTN, ND and uncontrolled sustained HTN compared with non-diabetics with CKD of the same stages.
authors: Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Korea.
authors: Se Won
authors: SW
authors: Oh
authors: Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Korea.
authors: Sang Youb
authors: SY
authors: Han
authors: Department of Internal Medicine, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Korea.
authors: Kum Hyun
authors: KH
authors: Han
authors: Department of Internal Medicine, National Medical Center, Seoul, Korea.
authors: Ran-hui
authors: RH
authors: Cha
authors: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
authors: Sejoong
authors: S
authors: Kim
authors: Department of Internal Medicine, Catholic University College of Medicine, Uijeongbu, Korea.
authors: Sun Ae
authors: SA
authors: Yoon
authors: Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea.
authors: Dong-Ryeol
authors: DR
authors: Rhu
authors: Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
authors: Jieun
authors: J
authors: Oh
authors: Department of Internal Medicine, Soonchunhyang University College of Medicine, Cheonan, Korea.
authors: Eun Young
authors: EY
authors: Lee
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
authors: Dong Ki
authors: DK
authors: Kim
authors: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.|Department of Medical Science, Seoul National University College of Medicine, Seoul, Korea.
authors: Yon Su
authors: YS
authors: Kim
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D013997:Time Factors