Blood pressure and progression of chronic kidney disease: Importance of systolic, diastolic, or diurnal variation

Mentari, Evelyn; Rahman, Mahboob

doi:10.1007/s11906-004-0060-2

Cited by 19 publications

(7 citation statements)

References 56 publications

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“…It was conceivable that the apparent concerted results among the published studies 23,24 and our analysis may disclose the possibility that SBP was a better predictor of CKD progression than DBP to some extent. Obesity is well recognized as a determinant of cardiovascular and many other chronic diseases.…”

Section: Discussionmentioning

confidence: 66%

Metabolic syndrome does not always play a critical role in decreased GFR

Cai

Wang

et al. 2016

Renal Failure

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Background There is a paucity of literature available as to the relationship between different levels of each metabolic syndrome (MetS) component and decreased GFR. In the present study, we aimed to demonstrate whether MetS always plays a critical role in decreased GFR. Methods A crosssectional study was conducted between February 2010 and September 2012, with 75,468 adults enrolled undergoing measurements of blood pressure as well as tests of blood and urine samples. Univariate and multivariable logistic regression analyses were performed to estimate the odds ratio (OR) with 95% confidence intervals (CI), and the chi-square test was used for categorical variables and described as a percentage. Results Of the 75,468 participants, 350 (0.5%) subjects met criteria for the decreased GFR, with a mean age of 48.79 ± 13.76 years. After adjustment for age, diastolic blood pressure and high-density lipoprotein were inversely related to decreased estimated glomerular filtration rate (eGFR) in multivariable analyses, with an OR (95% CI) of 0.57 (0.39-0.84) and 0.41 (0.24-0.72), respectively. The prevalence rate of CKD in critical group was 0.73% (154 of 21,127) and 0% (0 of 370) in noncritical group. In analysis stratified by the type of MetS components, the differences in noncritical group and the reference group were not statistically significant ( 2 ¼ 1.349, p40.05). Conclusions MetS does not always play a critical role in decreased GFR, with different levels of individual components of MetS exerting idiosyncratic effects in decreased eGFR. In fact, patients with abnormal body mass index, high triglycerides, and elevated fasting plasma glucose would not have impact on decreased GFR.

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Section: Discussionmentioning

confidence: 66%

Metabolic syndrome does not always play a critical role in decreased GFR

Cai

Wang

et al. 2016

Renal Failure

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“…This emphasis is largely due to reliance on measurement techniques to provide systolic readings only, as Doppler ultrasonography generally is used to obtain only systolic BP, particularly in cats, and recent evidence suggests that systolic BP is the more important determinant of hypertensive tissue damage in other species. 91,92 However, isolated systolic and diastolic hypertension can and do occur in dogs and cats and when properly diagnosed, warrant classification and management, as outlined below.…”

Section: Isolated Systolic or Diastolic Hypertensionmentioning

confidence: 99%

Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats

Brown

Atkins

Bagley

et al. 2007

Veterinary Internal Medicne

559

512

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Consensus Statements of the American College of Veterinary Internal Medicine (ACVIM) provide veterinarians with guidelines regarding the pathophysiology, diagnosis, or treatment of animal diseases. The foundation of the Consensus Statement is evidence‐based medicine, but if such evidence is conflicting or lacking, the panel provides interpretive recommendations on the basis of their collective expertise. The Consensus Statement is intended to be a guide for veterinarians, but it is not a statement of standard of care or a substitute for clinical judgment. Topics of statements and panel members to draft the statements are selected by the Board of Regents with input from the general membership. A draft prepared and input from Diplomates is solicited at the ACVIM Forum and via the ACVIM Web site and incorporated in a final version. This Consensus Statement was approved by the Board of Regents of the ACVIM before publication.

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“…Despite the rather persuasive evidence supporting BP and proteinuria reduction in the patient with CKD, there remain a number of unresolved issues with the use of antihypertensive medications in CKD. First, what are the most appropriate BP targets (<130 mm Hg) for optimal vascular (coronary artery disease and stroke) outcomes in patients with proteinuric and nonproteinuric CKD? 22 Second, are ACE inhibitors and ARBs needed in all forms of progressive renal disease, or can BP reduction alone suffice? 23–25 Third, what is the role of nocturnal BP control in forestalling the development/progression of proteinuric renal disease? 26 Fourth, what are the optimal doses of ACE inhibitors or ARBs in proteinuric CKD, and how can this best be assessed independent of BP reduction? 27 Finally, is there benefit from combining an ACE inhibitor with an ARB in proteinuric kidney disease? 28 …”

Section: Basis For Use Of Antihypertensive Medications In Ckdmentioning

confidence: 99%

The Kidney and Hypertension: Causes and Treatment

Sica¹

2008

J of Clinical Hypertension

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Chronic kidney disease is both a cause and a consequence of hypertension. Extracellular volume expansion is an important, if not the most important, contributing factor to hypertension seen in chronic kidney disease. Beyond volume expansion, chronic kidney disease‐related hypertension is without truly defining characteristics. Consequently, the sequencing of antihypertensive medications for the patient with chronic kidney disease and hypertension becomes arbitrary. Prescription practice in such patients should be mindful of the need for multiple drug classes with at least one of them being a diuretic. Blood pressure goals in the patient with chronic kidney disease and hypertension are set at lower levels than those for patients with essential hypertension alone. It remains to be determined to what level blood pressure should be lowered in the patient with chronic kidney disease, however.

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Blood pressure and progression of chronic kidney disease: Importance of systolic, diastolic, or diurnal variation

Cited by 19 publications

References 56 publications

Metabolic syndrome does not always play a critical role in decreased GFR

Metabolic syndrome does not always play a critical role in decreased GFR

Guidelines for the Identification, Evaluation, and Management of Systemic Hypertension in Dogs and Cats

The Kidney and Hypertension: Causes and Treatment

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