Nocturia as an Unrecognized Symptom of Uncontrolled Hypertension in Black Men Aged 35 to 49 Years

Ronald G Victor, Ning Li, Ciantel A Blyler, O'Neil R Mason, L Cindy Chang, Norma Priscilla B Moy, Mohammad A Rashid, Jeffrey P Weiss, Joel Handler, Jeffrey W Brettler, Michael B Sagisi, Florian Rader, Robert M Elashoff, Ronald G Victor, Ning Li, Ciantel A Blyler, O'Neil R Mason, L Cindy Chang, Norma Priscilla B Moy, Mohammad A Rashid, Jeffrey P Weiss, Joel Handler, Jeffrey W Brettler, Michael B Sagisi, Florian Rader, Robert M Elashoff

Abstract

Background Hypertension is assumed to be asymptomatic. Yet, clinically significant nocturia (≥2 nightly voids) constitutes a putative symptom of uncontrolled hypertension. Black men with hypertension may be prone to nocturia because of blunted nocturnal blood pressure ( BP ) dipping, diuretic drug use for hypertension, and comorbidity that predisposes to nocturia. Here, we test the hypothesis that nocturia is a common and potentially reversible symptom of uncontrolled hypertension in black men. Methods and Results We determined the strength of association between nocturia (≥2 nightly voids) and high BP (≥135/85 mm Hg) by conducting in-person health interviews and measuring BP with an automated monitor in a large community-based sample of black men in their barbershops. Because nocturia is prevalent and steeply age-dependent after age 50 years, we studied men aged 35 to 49 years. Among 1673 black men (mean age, 43±4 years [ SD ]), those with hypertension were 56% more likely than men with normotension to have nocturia after adjustment for diabetes mellitus and sleep apnea (adjusted odds ratio, 1.56; 95% CI , 1.25-1.94 [ P<0.0001]). Nocturia prevalence varied by hypertension status, ranging from 24% in men with normotension to 49% in men whose hypertension was medically treated but uncontrolled. Men with untreated hypertension were 39% more likely than men with normotension to report nocturia ( P=0.02), whereas men whose hypertension was treated and controlled were no more likely than men with normotension to report nocturia ( P=0.69). Conclusions Uncontrolled hypertension was an independent determinant of clinically important nocturia in a large cross-sectional community-based study of non-Hispanic black men aged 35 to 49 years. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unqiue identifier: NCT 02321618.

Trial registration: ClinicalTrials.gov NCT02321618.

Keywords: high blood pressure; hypertension; nocturia.

Figures

Figure 1
Figure 1
Age‐specific prevalence of nocturia (≥2 nightly voids) in non‐Hispanic black men aged 35 to 79 years: Los Angeles Barbershop Sample (blue bars) vs NHANES (National Health and Nutrition Examination Survey) data weighted to the US population (yellow bars). Weighted data are from the 2013–2014 survey, which was the most recent survey that asked about nocturia. Error bars represent 95% CIs.
Figure 2
Figure 2
Age‐specific prevalence of prostate disease in the Los Angeles Barbershop Sample. Data are by participant self‐report. Error bars represent standard error.
Figure 3
Figure 3
Adjusted odds ratios (ORs) and 95% CIs for nocturia plotted against group mean values for systolic blood pressure (SBP). *A statistically significant difference exists between the adjusted ORs for men with treated but uncontrolled hypertension (HTN) vs those with untreated hypertension (P=0.0008).

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