Both chronic kidney disease and nocturnal blood pressure associate with strokes in the elderly

Yuichiro Yano, George L. Bakris, Kunihiro Matsushita, Satoshi Hoshide, Kazuyuki Shimada, Kazuomi Kario

Research output: Contribution to journalArticlepeer-review


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). Conclusion: In elderly hypertensive patients, both high nocturnal SBP and CKD are independent risk factors for stroke.

Original languageEnglish (US)
Pages (from-to)195-203
Number of pages9
JournalAmerican Journal of Nephrology
Issue number3
StatePublished - Apr 12 2013


  • Chronic kidney disease
  • Elderly
  • Hypertension
  • Stroke

ASJC Scopus subject areas

  • Nephrology


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