Phenotyping the Association between Nocturia and Hypertension: A Systematic Review and Meta-Analysis

Abstract

The association between nocturia and hypertension has been widely reported yet remains poorly characterized, precluding a more refined understanding of blood pressure as it relates to the clinical urology setting. We synthesized current evidence on the relationship between nocturia and hypertension as a function of nocturia severity, age, gender, race, body mass index and diuretic use. Materials and Methods: We searched PubMedÒ, EMBASEÒ and Cochrane databases for studies published up to May 2020. Random effects meta-analyses were performed to identify pooled odds ratios for nocturia given the presence of hypertension. Meta-regression and subgroup analyses were performed to identify differences across study samples. Results: Of 1,193 identified studies, 25 met the criteria for inclusion. The overall pooled OR for the association of nocturia with hypertension was 1.25 (95% CI 1.21e1.28, p <0.001). Pooled estimates were 1.20 (1.16e1.25, p <0.001) and 1.30 (1.25e1.36, p <0.001) using a 1-void and 2-void cutoff for nocturia, respectively (p <0.001 between cutoffs). The association was more robust in patient-based (1.74 [1.54e1.98], p <0.001) vs community-based (1.24 [1.24e1.29], p <0.001) study samples (p <0.001). The association was stronger in females compared to males (1.45 [1.32e1.58] vs 1.28 [1.22e1.35], p <0.001), and Black (1.56 [1.25e1.94]) and Asian (1.28 [1.23e1.33]) vs White subgroups (1.16 [1.08e1.24]; p <0.05 for both). No effect was observed for age or body mass index. Evidence on diuretics was limited. Conclusions: Hypertension is associated with a 1.2-fold to 1.3-fold higher risk of nocturia. This association is more robust at a higher nocturia cutoff, in patientbased study samples, among females and in Black and Asian patients, but unrelated to age or body mass index.

Nocturia and electrocardiographic abnormalities among patients at an inner‐city cardiology clinic

“…Notably, the present study models explain only a fraction of the variance observed in the response variable (Nagelkerke R 2 ≤ 0.0985 across all models), suggesting that other variables are of larger importance. While current evidence supports the use of a 1‐void threshold for nocturia as employed in the present analysis, 14,15 there exists no consensus as to the optimal nocturnal voiding cutoff in nocturia research, 27 and it stands to reason that different criteria may differentially affect outcomes. Although the study sample was representative of the patient population treated at our institution, the present results may be biased by the disproportionate number of African‐Americans, females, and comorbidity burden, such that future studies are needed to determine whether the present study findings may be generalized to meaningfully characterize the relationship between nocturia and hypertension in other clinical and community settings.…”

“…As LVH, LAE, and QTC prolongation are all characteristic of hypertension, a threshold of ≥1 void per night was predefined for nocturia in view of prior literature on 24-h ambulatory blood pressure monitoring, which has identified a pronounced difference in nocturnal blood pressures between subjects with zero versus 1 nocturnal void, 14 as well as population-level evidence of a significant association between hypertension and ≥1 nocturnal voids. 15 Univariate associations between the aforementioned covariates and the presence of nocturia were explored. The Cochran-Mantel-Haenszel test was used to measure to strength of the association between nocturia and LVH, LAE, and QTc prolongation after stratifying on the basis of age.…”

A methodologic survey on use of the GRADE approach in evidence syntheses published in high-impact factor urology and nephrology journals

“…The initial search yielded 767 entries, of which 322 were excluded that were not SRs. Of the 445 SRs identified, 60 met the eligibility criteria [ 7 – 66 ]. Out of the 60 studies, 11 studies [ 56 – 66 ] (18.33%) did not report on outcome-specific rating, which refers to certainty of evidence of individual studies was assessed or overall certainty of the body of evidence was rated (Supplementary Table S 1 ).…”

“…Of the 445 SRs identified, 60 met the eligibility criteria [ 7 – 66 ]. Out of the 60 studies, 11 studies [ 56 – 66 ] (18.33%) did not report on outcome-specific rating, which refers to certainty of evidence of individual studies was assessed or overall certainty of the body of evidence was rated (Supplementary Table S 1 ). Therefore, a total of 49 SRs (81.67%) that rated the outcome-specific certainty of evidence were included in our methodologic survey.…”

Association Between Before-bedtime Passive Body Heating and Nocturia During the Cold Season Among Older Adults

“…3 The condition is associated with various morbidities, such as obesity, diabetes, hypertension, cardiac disease, and depression; these morbidities may contribute to a higher risk of mortality. [4][5][6] Cold exposure results in lower urinary tract symptoms (LUTS). Previously, low ambient temperature-induced detrusor overactivity in rats was found to be correlated with decreased skin temperature.…”