Above-threshold AUC was associated with greater LVMI but added limited information beyond daytime and nighttime mean SBP in this cohort.
Key Findings
Results
Daytime and nighttime above-threshold SBP AUC, entered jointly, were significantly associated with left ventricular mass index in adults with non-dialysis CKD.
Cross-sectional study of 212 Chinese adults with non-dialysis CKD who underwent ambulatory blood pressure monitoring and echocardiography.
Daytime AUC above 135 mmHg and nighttime AUC above 120 mmHg were entered jointly in the model.
Together, daytime and nighttime AUC were significantly associated with LVMI (P < 0.001; adjusted R2 = 0.345).
Results
Moving from the 25th to the 75th percentile of AUC corresponded to higher adjusted LVMI, with a larger effect for nighttime than daytime AUC.
Adjusted LVMI was 3.46 g/m2·7 higher for daytime AUC from the 25th to the 75th percentile.
Adjusted LVMI was 5.56 g/m2·7 higher for nighttime AUC over the same percentile range.
Results
Most of the cohort-average above-threshold SBP burden was attributable to daytime and nighttime mean SBP.
AUC attributable to daytime and nighttime mean SBP accounted for 89.7% of the cohort-average above-threshold burden.
The remainder reflects AUC not captured by the period means.
Results
The portion of AUC not explained by daytime and nighttime mean SBP was not significantly associated with LVMI after adjustment for those means.
The residual AUC association was 0.69 g/m2·7 per interquartile range.
The 95% confidence interval was -2.00 to 3.37, spanning zero.
This indicates that above-threshold AUC added limited information beyond daytime and nighttime mean SBP.
What This Means
This study looked at 212 Chinese adults with chronic kidney disease who were not on dialysis. Each wore a 24-hour blood pressure monitor and had a heart ultrasound. The researchers asked whether a measure combining how high and how long systolic blood pressure stayed above reference levels (the area under the curve, or AUC) said more about heart muscle thickness (left ventricular mass) than simple average daytime and nighttime blood pressure.
The AUC measure was linked to greater left ventricular mass, and nighttime AUC showed a somewhat larger link than daytime AUC. However, about 90% of the above-threshold burden was explained by the average daytime and nighttime blood pressure. The small leftover portion was not significantly linked to heart mass once those averages were accounted for.
This research suggests that, in people with CKD, average daytime and nighttime systolic pressure may capture most of the information that the more complex AUC measure provides about heart mass. The study was cross-sectional and had a modest sample, so it cannot show cause and effect or rule out small added value of AUC.
Zhang Z, Dong X, Ding X, Jiang W, Fang Y. (2026). Above-Threshold Ambulatory Systolic Pressure and Left Ventricular Mass in Chronic Kidney Disease: Does AUC Add Beyond Mean Pressure?. Journal of clinical hypertension (Greenwich, Conn.). https://doi.org/10.1111/jch.70378