Blood pressure variability and outcomes in chronic kidney disease

Iorio, Biagio Di; Pota, Andrea; Sirico, Maria Luisa; Torraca, Serena; Micco, Lucia Di; Rubino, Roberto; Guastaferro, Pasquale; Bellasi, Antonio

doi:10.1093/ndt/gfs328

Cited by 65 publications

(67 citation statements)

References 28 publications

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“…To calculate VVV of BP, we used data from seven followup visits that occurred 6,9,12,16,20,24, and 28 months after randomization. We started at the 6-month follow-up visit to avoid potential confounding by BP changes that occurred between randomization and that visit (mean BP fell by approximately 8/5 mmHg).…”

Section: Study Visits Bp Measurements and Calculation Of Vvv Of Bpmentioning

confidence: 99%

“…In some but not all studies, persons with higher BP variability had more rapid CKD progression as measured by declines in eGFR or increases in urinary albumin (9)(10)(11)(12)(13). Some studies of persons with diabetes have shown an association of BP variability with more clinically impactful renal outcomes, including ESRD (10,14), but such an association has not been shown among persons without diabetes.…”

Section: Introductionmentioning

confidence: 99%

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Visit-to-Visit Variability of BP and CKD Outcomes

Whittle

Lynch²,

Tanner³

et al. 2016

Clinical Journal of the American Society of Nephrology

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Background and objectives Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.Design, setting, participants, & measurements We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril. The composite outcome included incident ESRD after assessment of SD of systolic BP or $50% decline in eGFR between 24 months and 48 or 72 months after randomization. We repeated the analyses using average real variability and peak value of systolic BP and for visit-to-visit variability of diastolic BP.Results Over a mean follow-up of 3.5 years, 297 outcomes occurred. After multivariable adjustment, including baseline eGFR and mean systolic BP, the hazard ratios for the composite end point were 1.29 (95% confidence interval [95% CI], 0.75 to 2.22), 1.76 (95% CI, 1.06 to 2.91), 1.46 (95% CI, 0.88 to 2.45), and 2.05 (95% CI, 1.25 to 3.36) for the second through fifth (SD of systolic BP =6. 63-8.82, 8.83-11.14, 11.15-14.56, and .14.56 mmHg, respectively) versus the first (SD of systolic BP ,6.63 mmHg) quintile of SD of systolic BP, respectively (P trend =0.004). The association was similar when ESRD and a 50% decline in eGFR were analyzed separately, for other measures of visit-to-visit variability of systolic BP, and for visit-to-visit variability of diastolic BP. ConclusionsHigher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.

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Section: Study Visits Bp Measurements and Calculation Of Vvv Of Bpmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Visit-to-Visit Variability of BP and CKD Outcomes

Whittle

Lynch²,

Tanner³

et al. 2016

Clinical Journal of the American Society of Nephrology

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“…Formally considered "noise," greater degrees of systolic BP visitto-visit variability (SBV) may be associated with an increased incidence of stroke and overall mortality in several cohort studies (1)(2)(3)(4). In a Northern European cohort, for example, individuals in the top decile of SBV had a 3.25-fold higher risk of subsequent stroke compared with those in the lowest decile (1).…”

Section: Introductionmentioning

confidence: 99%

Association of BP Variability with Mortality among African Americans with CKD

McMullan

Bakris

Phillips

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.Design, setting, participants, & measurements This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.Results Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.Conclusions In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.

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“…A longitudinal retrospective, observational, and multicentre study has found an association between systolic BPV, defined as the ratio of the SD to the mean systolic BP of five values recorded during 4-5 months, and the risk of death but not of progression to dialysis in 374 elderly subjects with chronic renal failure [56]. In addition, Yokota et al demonstrated that SD and CV of office systolic BP measured at 12 consecutive visits were significantly associated with deterioration of renal function in patients with nondiabetic chronic kidney disease [57].…”

Section: Impact Of Long-term Bpv On Target Organ Damage and Cardiovasmentioning

confidence: 99%

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

Höcht

2013

ISRN Hypertension

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Blood pressure variability (BPV) is considered nowadays a novel risk factor for cardiovascular disease. Early findings in sinoaortic denervated rats have clearly shown that enhanced fluctuation of blood pressure induced left ventricular hypertrophy, vascular stiffness, and renal lesion. A large number of clinical trials confirm that short-term and long-term blood pressure variability independently contributes to target organ damage, cardiovascular events, and mortality not only in hypertensive patients but also in subjects with diabetes mellitus and chronic kidney disease. Therefore, amelioration of BPV has been suggested as an additional target of the treatment of cardiovascular diseases. Preliminary evidence obtained from meta-analysis and controlled clinical trials has shown that antihypertensive classes differ in their ability to control excessive BP fluctuations with an impact in the prevention of cardiovascular events. Calcium channel blockers seem to be more effective than other blood pressure lowering drugs for the reduction of short-term and long-term BPV. In order to increase actual knowledge regarding the prognostic value and therapeutic significance of BPV in cardiovascular disease, there is a need for additional clinical studies specifically designed for the study of the relevance of short-term and long-term BPV control by antihypertensive drugs.

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Blood pressure variability and outcomes in chronic kidney disease

Abstract: Current findings suggest that SBPV may be of use for risk stratification in CKD patients.

Cited by 65 publications

References 28 publications

Visit-to-Visit Variability of BP and CKD Outcomes

Visit-to-Visit Variability of BP and CKD Outcomes

Association of BP Variability with Mortality among African Americans with CKD

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

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