Association between 24-hour blood pressure variability and chronic kidney disease: a cross-sectional analysis of African Americans participating in the Jackson heart study

Abstract

BackgroundStudies suggest 24-h blood pressure (BP) variability has prognostic value for cardiovascular disease. Several factors associated with high 24-h BP variability are also common among individuals with chronic kidney disease (CKD). We hypothesized 24-h BP variability would be higher for individuals with versus without CKD.MethodsWe analyzed 1,022 Jackson Heart Study participants who underwent ambulatory blood pressure monitoring (ABPM). Twenty-four hour BP variability was defined by two metrics: day-night standard deviation (SDdn) and average real variability (ARV). CKD was defined as ACR ≥30 mg/g or eGFR <60 mL/min/1.73 m2.ResultsThe mean SDdn of systolic BP (SBP) was 10.2 ± 0.2 and 9.1 ± 0.1 mmHg and the mean ARV of SBP was 9.2 ± 0.2 and 8.6 ± 0.1 mmHg for those with and without CKD, respectively (each p ≤ 0.001). After adjustment for age and sex, SDdn and ARV were 0.98 mmHg (95 % CI 0.59, 1.38) and 0.52 mmHg (95 % CI 0.18, 0.86), respectively, higher among participants with versus without CKD. These differences were not statistically significant after further multivariable adjustment including 24-h mean SBP. Older age, and higher total cholesterol and 24-h mean SBP were associated with higher SDdn and ARV of SBP among participants with CKD. Mean SDdn and ARV of diastolic BP (DBP) were higher for participants with versus without CKD but these associations were not present after multivariable adjustment.ConclusionData from the current study suggest that CKD is associated with higher 24-h BP variability, but the association is primarily explained by higher mean BP among those with CKD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-015-0085-6) contains supplementary material, which is available to authorized users.

Long‐Term Visit‐to‐Visit Blood Pressure Variability and Renal Function Decline in Patients With Hypertension Over 15 Years

“…The question of whether BPV causes CKD or CKD worsens BPV has been raised . The Jackson Heart Study showed that patients with CKD had higher BPV compared to those without CKD . Our study also showed that those with CKD at the end of 15 years have higher BPV compared to those without CKD.…”

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

“…We could not confirm that eGFR was associated with neither diurnal nor nocturnal BPV as shown by Tanner and coworkers [25]. They demonstrated that in a large sample of patients with CKD, BPV defined by day-night standard deviation and average real variability, was higher among participants with versus without CKD.…”

The Cerebrovascular-Chronic Kidney Disease Connection: Perspectives and Mechanisms

“…CKD is associated with increased BP variability partly due to arterial stiffness [24]. Greater BP variability is associated with increased risk of hemorrhagic stroke in stage 3–4 CKD patients [25] and is a strong predictor of mortality in hemodialysis patients [26].…”