Blood Pressure Variability and the Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis

Yang, Luxi; Li, Jian; Wei, Wei; Pu, Yajun; Zhang, Ling; Cui, Tianlei; Ma, Liang; Wang, Bo; Zhao, Yuliang; Fu, Ping

doi:10.1007/s11606-022-08001-6

Cited by 7 publications

(6 citation statements)

References 57 publications

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“…The relationship between visit-to-visit BPV and cardiovascular outcomes in the general population was widely investigated [2]. In CKD patients, BPV was also associated with death and CKD progression [7]. It is worth noting that this relationship is not causal, as CKD can influence BPV.…”

Section: Discussionmentioning

confidence: 99%

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Association between blood pressure variability and risk of kidney function decline in hypertensive patients without chronic kidney disease: a post hoc analysis of Systolic Blood Pressure Intervention Trial study

Wang,

Li,

Jiang

et al. 2024

Journal of Hypertension

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Background: Blood pressure variability (BPV) is a risk factor for poor kidney function independent of blood pressure (BP) in chronic kidney disease (CKD). Little is known about the association between kidney function decline and BPV in hypertensive patients without CKD. Methods: A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. BPV was measured as standard deviation (SD) and average real variability (ARV). Cox proportional hazard models were employed to explore the relationship between BPV and incident CKD and albuminuria. Results: A total of 5700 patients were included, with a mean age of 66.4 years old. During a median of 3.29 years follow-up, 150 (2.6%) patients developed CKD and 222 (7.2%) patients developed albuminuria. Patients were divided into four groups according to the quartiles of BPV. Compared with SBPV Q1, the incidence of CKD was higher in SBPV Q2–Q4; hazard ratios and 95% confidence interval were 1.81 (1.07–3.04), 1.85 (1.10–3.12) and 1.90 (1.13–3.19), respectively. The association between incident CKD and albuminuria with DBPV was less significant than SBPV. Similar results were found when measuring BPV as ARV and SD. No interaction was detected in BP-lowering strategy and SBPV on incident CKD and albuminuria (P > 0.05). Conclusion: This study found that BPV was a risk factor for incident CKD and albuminuria in patients without CKD, especially SBPV. Although intensive BP control increased the risk of CKD, the association between SBPV and kidney function decline did not differ between the two treatment groups. Registration: URL: https://clinicaltrials.gov/, Unique identifier: NCT01206062

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Section: Discussionmentioning

confidence: 99%

“…In recent years, more evidence indicated that BPV was independently associated with the progression of kidney damage [5][6][7]. One study from the Korean National Health Insurance system revealed that both SBPV and DBP variability (DBPV) were independently associated with an increased incidence of end-stage renal disease (ESRD) [8].…”

Section: Introductionmentioning

confidence: 99%

Association between blood pressure variability and risk of kidney function decline in hypertensive patients without chronic kidney disease: a post hoc analysis of Systolic Blood Pressure Intervention Trial study

Wang,

Li,

Jiang

et al. 2024

Journal of Hypertension

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“…The main mechanisms of target organ damage by BPV are as follows:(1) inflammatory reaction [20] :When BPV increases, the abnormal longitudinal shear force and ring tension on the blood vessel wall and platelets increase, then promotes the endothelial injury and platelet activation, increases the synthesis and release of inflammatory factors, especially IL-6, promotes the occurrence of inflammatory reaction, and finally accelerates the occurrence and development of atherosclerosis； (2) The activation of renin-angiotensin-aldosterone (RAS) system damages cardiomyocytes [32]: increased blood pressure variability can cause the activation of RAS system, promote cardiomyocyte protein synthesis, DNA synthesis and cell apoptosis in myocardial fibroblasts and other mechanisms lead to ventricular remodeling and left ventricular function change; (3)Direct damage to endothelial cells [33]: either too high or too low blood pressure has adverse effects on the body, and the rapid decrease in blood pressure may lead to obvious or subclinical ischemic injury to the target organs, while the sudden increase in blood pressure can lead to capillary endothelial shear stress injury. Blood pressure variability is considered an independent predictor of early renal impairment [34], also a poor prognostic factor for the occurrence, progression, and severity of renal outcomes in patients undergoing CKD and hemodialysis [35]. Chronic kidney disease is also an important risk factor for cardiovascular disease, infection, and cognitive impairment [36].…”

Section: Blood Pressure Variability and Prognosis Of Patients On Main...mentioning

confidence: 99%

Influencing factors and prognosis of blood pressure variability in maintenance hemodialysis patients

2024

IJFM

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The fluctuation of Blood pressure within a certain period of time is called Blood pressure variability (BPV). Recent studies have confirmed its value in predicting cardiovascular events and death. However, large changes in hemodynamics and internal environment in dialysis patients due to dialysis treatment in a short period of time, often face more complex blood pressure variability. At present, there are a variety of research on BPV, and the pathogenesis and influencing factors of BPV are numerous. In this paper, the variability of blood pressure in maintenance hemodialysis patients and its influencing factors were reviewed to provide reference for the management of hypertension in dialysis patients.

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“…Several studies assessed the impact of visit-to-visit or day-to day BPV in CKD patients on kidney function, dementia and mortality [23][24][25][26][27] but to our knowledge very few evaluated the seasonal variation of BP in CKD patients [28]. This study aims to find out whether there is a seasonal variation of blood pressure in CKD and non-CKD patients living in a Mediterranean climate, whether this variation entails frequent adjustment of treatment, and finally whether it impacts renal and survival outcomes.…”

Section: Introductionmentioning

confidence: 99%

Acknowledging the impact of seasonal blood pressure variation in hypertensive CKD and non-CKD patients living in a Mediterranean climate

Charbel,

El Koubayati,

Kharsa

et al. 2023

PLoS ONE

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Background This study aims to assess seasonal blood pressure (BP) variation in chronic kidney disease (CKD) and non-CKD patients living in a Mediterranean climate, and to find out if this variation entails significant adjustment of treatment and if it impacts renal outcomes and mortality. Methods This retrospective study included all hypertensive patients seen between February 2006 and April 2020 in two Lebanese clinics. Regression analyses were used to assess the association of seasonal BP variability and treatment adjustment with eGFR change from baseline, dialysis initiation and death. Results A total of 398 patients of 64.2 ±13.9 years were followed for 51.1 ±44.3 months, 67% had eGFR< 60 mL/min. Mean systolic and diastolic BP was 137.7 ±14.7 and 76.5 ±9.5 mmHg respectively. Systolic and diastolic BP were significantly lower in the warm season in CKD and non-CKD patients (P<0.001). The majority (91.4%) needed seasonal treatment modifications. After adjustment to age, sex, baseline eGFR, BP and number of antihypertensive drugs, we found a significant loss of eGFR with treatment modifications in both seasons, double risk of dialysis with the increase of antihypertensive treatment in both seasons and a 2.5 more risk of death with reduced treatment in the warm season. Conclusion This study confirmed the seasonal BP variability in CKD and non-CKD patients from a Mediterranean climate. All types of treatment adjustment were associated with eGFR loss. Low BP in the warm season was highly associated with death.

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Blood Pressure Variability and the Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis

Cited by 7 publications

References 57 publications

Association between blood pressure variability and risk of kidney function decline in hypertensive patients without chronic kidney disease: a post hoc analysis of Systolic Blood Pressure Intervention Trial study

Association between blood pressure variability and risk of kidney function decline in hypertensive patients without chronic kidney disease: a post hoc analysis of Systolic Blood Pressure Intervention Trial study

Influencing factors and prognosis of blood pressure variability in maintenance hemodialysis patients

Acknowledging the impact of seasonal blood pressure variation in hypertensive CKD and non-CKD patients living in a Mediterranean climate

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