JAMA Netw Open. 2026 Jan 2;9(1):e2554035. doi: 10.1001/jamanetworkopen.2025.54035.
ABSTRACT
IMPORTANCE: The 2025 American College of Cardiology/American Heart Association (ACC/AHA) blood pressure (BP) guideline introduced new hypertension criteria. However, the association between newly defined nocturnal stage 1 hypertension (nocturnal BP 110-120/65-70 mm Hg) and kidney function progression in the population not receiving dialysis with chronic kidney disease (CKD) in China remains unclear.
OBJECTIVE: To determine whether nocturnal stage 1 hypertension as defined by 2025 ACC/AHA guidelines in patients with CKD is associated with kidney function progression.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study involving patients with CKD not receiving dialysis was conducted in China at the Third Affiliated Hospital of Sun Yat-sen University from August 2010 to December 2017 and at the Fifth Affiliated Hospital of Sun Yat-sen University from November 2017 to December 2024.
EXPOSURE: Participants were categorized into 3 groups based on nocturnal BP measurements according to the 2025 ACC/AHA guidelines: nonhypertension (nocturnal BP <110/65 mm Hg), stage 1 hypertension (nocturnal BP 110-120/65-70 mm Hg), and stage 2 hypertension (nocturnal BP ≥120/70 mm Hg).
MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of kidney failure requiring replacement therapy (KFRT) and worsening kidney function (WKF). Secondary outcomes included the individual components of the primary outcome. Cox regression models were employed to assess the association between nocturnal stage 1 hypertension and outcomes.
RESULTS: Among 2418 participants with CKD stage 1 through 4 not receiving dialysis included in the study, 1412 (58.4%) were men, the mean (SD) age was 45.4 (14.4) years, 436 (18.0%) had nocturnal nonhypertension, 345 (14.3%) had nocturnal stage 1 hypertension, and 1637 (67.7%) had nocturnal stage 2 hypertension. Over a median (IQR) follow-up of 3.9 (1.5-4.7) years, 394 composite kidney outcomes, 203 cases of KFRT, and 235 instances of WKF were recorded. After adjusting for confounders, nocturnal stage 1 hypertension (compared with nocturnal nonhypertension) was independently associated with an increased risk of KFRT (hazard ratio [HR], 2.37; 95% CI, 1.17-4.82), WKF (HR, 3.79; 95% CI, 1.04-13.84), and the composite kidney outcome (HR, 2.49; 95% CI, 1.31-4.72). In the older population (aged ≥65 years), nocturnal BP less than 110/65 mm Hg was associated with a higher risk of WKF and the composite kidney outcome compared with nocturnal BP in the range of 110/65 to 120/70 mm Hg.
CONCLUSIONS AND RELEVANCE: In this cohort study of adults with CKD not receiving dialysis, nocturnal stage 1 hypertension as defined by the 2025 ACC/AHA guidelines was independently associated with an increased risk of CKD progression.
PMID:41533374 | DOI:10.1001/jamanetworkopen.2025.54035