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Nocturnal Stage 1 Hypertension Defined by 2025 Guidelines in Adults With Chronic Kidney Disease

Ting Zhang1,2, Zhengping Zhou1,2, Qiong Li1,2

  • 1Division of Nephrology, Department of Medicine, the Fifth Affiliated Hospital Sun Yat-sen University, Zhuhai, Guangdong, China.

JAMA Network Open
|January 14, 2026
PubMed

Insights

New 2025 guidelines define stage 1 hypertension. Nocturnal stage 1 hypertension in Chinese adults with chronic kidney disease (CKD) significantly increases the risk of kidney function decline and failure.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • The 2025 American College of Cardiology/American Heart Association (ACC/AHA) guidelines established new blood pressure (BP) criteria.
  • The implications of newly defined nocturnal stage 1 hypertension (110-120/65-70 mm Hg) for chronic kidney disease (CKD) progression in Chinese patients not on dialysis are not well understood.

Purpose of the Study:

  • To investigate the association between nocturnal stage 1 hypertension, as per the 2025 ACC/AHA guidelines, and kidney function progression in patients with CKD.
  • To evaluate the risk of kidney failure requiring replacement therapy (KFRT) and worsening kidney function (WKF) in this population.

Main Methods:

  • A retrospective cohort study was conducted involving 2418 adult patients with CKD stages 1-4 not receiving dialysis in China.
  • Participants were classified into nonhypertension (<110/65 mm Hg), stage 1 hypertension (110-120/65-70 mm Hg), and stage 2 (≥120/70 mm Hg) based on nocturnal BP.
  • Cox regression models were used to analyze the association between nocturnal hypertension categories and kidney outcomes over a median follow-up of 3.9 years.

Main Results:

  • Nocturnal stage 1 hypertension was independently associated with a significantly increased risk of KFRT (HR, 2.37), WKF (HR, 3.79), and composite kidney outcomes (HR, 2.49) compared to nonhypertension.
  • In older adults (≥65 years), nocturnal BP <110/65 mm Hg was linked to higher risks of WKF and composite kidney outcomes compared to 110/65-120/70 mm Hg.

Conclusions:

  • Nocturnal stage 1 hypertension, according to the 2025 ACC/AHA guidelines, is an independent risk factor for CKD progression in patients not on dialysis.
  • These findings highlight the importance of monitoring nocturnal BP in CKD management and suggest potential adjustments to hypertension thresholds for this population.
Abstract

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