Management Strategies for Nocturia - Beyond the Abstract

In Current Urology Reports, we have recently provided a comprehensive review of the behavioral, medical, and surgical management strategies for nocturia (secondary to nocturnal polyuria, diminished bladder capacity, and global polyuria) with an emphasis on beginning treatment with the more conservative behavioral modifications. One aspect of our review article that we would like to further highlight is the association between hypertension and nocturia.

As clinical practitioners at an institution with marked levels of poorly controlled hypertensive patients, this association will have a great impact on our clinical management. A recent cross-sectional study found that uncontrolled hypertension is an independent determinant of nocturia amongst black men aged 35-49 years old.1 However, even more importantly, this study found that patients with uncontrolled hypertension, despite attempted medical management, were at greater odds of experiencing nocturia compared to patients with untreated hypertension. This is likely secondary to the combination of blunting of nocturnal blood pressure dipping amongst hypertensives and the side effect profile of the hypertensive medications.

These findings underscore the importance of urologists working closely with patients’ primary care physicians to determine an effective blood pressure regimen. Practitioners often have to try a combination of different medications with different mechanisms of action to adequately control a patient’s blood pressure, which may take a substantial amount of time. However, especially in patients suffering from severe symptomatic nocturia, we must stay vigilant about adjusting medications after realizing a current regimen trial is unsuccessful. Combining the side effect profiles of hypertensive medications on top of poorly controlled hypertension will only worsen our patient’s attempts to get a full night sleep devoid of multiple trips to the restroom.

Written by: Danielle J. Gordon, Curran J. Emeruwa, Jeffrey P. Weiss, MD, Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York, USA

References:

  1. Victor RG, Li N, Blyler CA, et al. Nocturia as an unrecognized symptom of uncontrolled hypertension in Black men aged 35 to 49 years. J Am Heart Assoc. 2019.  https://doi.org/10.1161/jaha.118.010794
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