Phenotyping the Association Between Nocturia and Hypertension: A Systematic Review and Meta-Analysis.
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, sex, race, BMI, and diuretic use.We searched PubMed, EMBASE, and Cochrane databases for studies published up to May 2020. Random effects meta-analyses were performed to identify pooled odds ratios (ORs) for nocturia given the presence of hypertension. Meta-regression and subgroup analyses were performed to identify differences across study samples.Of 1193 identified studies, 25 met the criteria for inclusion. The overall pooled OR for the association of nocturia with hypertension was 1.25 (95% CI 1.21-1.28, p <0.001). Pooled estimates were 1.20 (1.16-1.25, p <0.001) and 1.30 (1.25-1.36, p <0.001) using a 1- and 2-void cutoff for nocturia, respectively (p <0.001 between cutoffs). The association was more robust in patient-based (1.74 [1.54-1.98], p <0.001) versus community-based (1.24 [1.24-1.29], p <0.001) study samples (p <0.001). The association was stronger in females compared to males (1.45 [1.32-1.58] vs. 1.28 [1.22-1.35], p <0.001), and African-American (1.56 [1.25-1.94]) and Asian (1.28 [1.23-1.33]) versus Caucasian subgroups (1.16 [1.08-1.24]) (p <0.05 for both). No effect was observed for age or BMI. Evidence on diuretics was limited.Hypertension is associated with a 1.2-1.3-fold higher risk of nocturia. This association is more robust at a higher nocturia cutoff, in patient-based study samples, amongst females, and in African-Americans and Asians, but unrelated to age or BMI.