Blood pressure variability increases with advancing chronic kidney disease stage

Sarafidis, Pantelis A.; Ruilope, Luís M.; Loutradis, Charalampos; Gorostidi, Manuel; Sierra, Alejandro de la; Cruz, Juan; Vinyoles, Ernest; Garrote, J.A. Divisón; Segura, Julián; Banegas, José R.

doi:10.1097/hjh.0000000000001670

Cited by 78 publications

(51 citation statements)

References 45 publications

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“…The pathophysiological meaning of these differences is unclear, but it should be emphasized that BPV (in particular systolic BPV) correlates with arterial stiffness, which in turn is related to aging and increasing SBP (but not DBP) levels. In fact, a recent large study on the relationship between BPV and chronic kidney disease (where arterial stiffness is also relevant) showed that with worsening renal function, an increase occurs in systolic, but not in diastolic, BPV . This might imply that systolic BPV reflects primarily vascular stiffness and aging, while diastolic BPV has a different pathophysiological background such as, for instance, impaired autonomic function with increased sympathetic activity, and endothelial dysfunction …”

Section: Clinical Relevancementioning

confidence: 99%

“…Kaplan-Meier curves are shown for subjects with values above (black lines) and below (gray lines) the population median. From Mancia et al 7 used by permission in diastolic, BPV 12. This might imply that systolic BPV reflects primarily vascular stiffness and aging, while diastolic BPV has a different pathophysiological background such as, for instance, impaired autonomic function with increased sympathetic activity, and endothelial dysfunction 13.…”

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confidence: 99%

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Blood pressure variability: clinical relevance and application

Parati

Stergiou

Dolan

et al. 2018

J of Clinical Hypertension

214

208

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Blood pressure variability is an entity that characterizes the continuous and dynamic fluctuations that occur in blood pressure levels throughout a lifetime. This phenomenon has a complex and yet not fully understood physiological background and can be evaluated over time spans ranging from seconds to years. The present paper provides a short overview of methodological aspects, clinical relevance, and potential therapeutic interventions related to the management of blood pressure variability.

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Section: Clinical Relevancementioning

confidence: 99%

mentioning

confidence: 99%

Blood pressure variability: clinical relevance and application

Parati

Stergiou

Dolan

et al. 2018

J of Clinical Hypertension

214

208

View full text Add to dashboard Cite

show abstract

“…According to time interval, this metric is divided into long‐term BPV (eg, visit‐by‐visit BPV), mid‐term BPV (eg, day‐by‐day BPV within days or weeks), and short‐term BPV (eg, beat‐to‐beat and hour‐to‐hour BPV) . CKD is associated with increased BPV, and this association gets stronger with CKD stages advancing . As BPV has been shown to be a risk factor for cardiovascular events and all‐cause mortality, it may be related with the high mortality risk of CKD patients with VC.…”

Section: Introductionmentioning

confidence: 99%

“…10 CKD is associated with increased BPV, and this association gets stronger with CKD stages advancing. 11 As BPV has been shown to be a risk factor for cardiovascular events and all-cause mortality, [12][13][14][15] it may be related with the high mortality risk of CKD patients with VC.…”

Section: Introductionmentioning

confidence: 99%

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Liao

Wang

et al. 2019

Nephrology

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Aim Vascular calcification (VC) is a common complication in chronic kidney disease (CKD) and has been shown to be associated with increased cardiovascular events and mortality. This study was to explore the role of Wnt‐signaling pathway in CKD VC, and the association between VC and blood pressure variability (BPV) which is a risk factor of cardiovascular events. Methods Adult male Sprague‐Dawley rats were divided into adenine‐induced CKD group (n = 5), 5/6 nephrectomy CKD group (n = 5), sham group (n = 5) and control group (n = 5). Low‐calcium‐high‐phosphate diets were introduced to induce vascular calcification. Both daytime (hour‐to‐hour during the day) and mid‐term (day‐to‐day for 9 days) blood pressure (BP) were collected and analyzed for BPV metrics. At sacrifice, kidney, heart and aorta samples were taken for histological analyses. Calcium deposition in aorta was identified with Alizarin Red stain and graded. Immunohistochemistry stain and western blot were performed for Wnt3a, Wnt5a, β‐catenin, sclerostin, osteopontin, and α‐SMA. Results Compared with control rats, CKD rats suffered from markedly severer VC (Grade 2.6 ± 0.2 and 1.8 ± 0.8 vs 0.0 ± 0.0 and 0.2 ± 0.4, P = .0010). VC was positively correlated with vascular Wnt3a and β‐catenin expression (P = .0032 and .0000), but not significantly associated with Wnta5a or sclerostin. Besides, CKD rats showed increased BPV (P < .001), which was also positively correlated with VC. Conclusion We confirmed that CKD rats had enhanced Wnt‐signaling in vascular tissue and severer aorta calcification together with increased BPV. Wnt pathway may be a potential target in future VC and BPV management in CKD.

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“…BP variability (BPV) is also increased in patients with DM and is mainly associated with deranged autonomic control of circulation and increased arterial stiffness [8]. Similarly, results from a large cohort study from the Spanish ambulatory blood pressure monitoring (ABPM) registry suggested that shortterm BPV was higher in patients with compared to those without CKD and all indexes of systolic BPV were gradually increasing with advancing CKD stages [9].…”

Section: Introductionmentioning

confidence: 99%

Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Diabetic and Non-Diabetic Chronic Kidney Disease

et al. 2020

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Background: Diabetic kidney disease is the leading cause of end-stage renal disease worldwide. Whether diabetes mellitus (DM) is an additional factor leading to elevated blood pressure (BP) levels and BP variability (BPV) in patients with chronic kidney disease (CKD) is unknown. This study aimed to compare ambulatory BP levels, BP trends and BPV in diabetic and non-diabetic patients with CKD. Methods: This study included 48 diabetic and 48 non-diabetic adult patients (> 18 years) with CKD (estimated glomerular filtration rate [eGFR] < 90 and ≥15 mL/min/1.73 m 2 ), matched in a 1: 1 ratio for age, sex and eGFR within each CKD stage (2, 3a, 3b and 4). All patients underwent 24-h ambulatory BP measurement with the Mobil-O-graph device. To evaluate the effect of DM and time on the trajectories of 24-h BP levels, we performed two-way mixed ANOVA analysis for repeated measurements using hourly means. BPV was calculated with val-idated formulas. Results: In total, patients with DM had significantly higher 24-h systolic BP (SBP; 132.13 ± 10.71 vs. 124.16 ± 11.45; p = 0.001) and pulse pressure (PP; 57.1 ± 9.6 vs. 49.5 ± 10.9; p < 0.001), but similar 24-h diastolic BP (DBP; 75.00 ± 8.43 vs. 74.62 ± 6.86 mm Hg; p = 0.809) compared to patients without DM. A similar trend was evident across all CKD stages. The effect of DM on BP trajectories during the recording period was significant for SBP (F = 18.766, p < 0.001, partial η 2 = 0.261) and marginally significant for DBP (F = 3.782, p = 0.057, partial η 2 = 0.067). Twenty-four hour SBP SD, weighted SD (wSD) and average real variability (ARV; 10.94 ± 2.75 vs. 9.46 ± 2.10; p = 0.004), as well as 24 h DBP SD, wSD, coefficient of variation (CV) and ARV (8.23 ± 2.10 vs. 7.10 ± 1.33; p = 0.002) were significantly higher in diabetic compared to non-diabetic CKD patients. Conclusions: Ambulatory SBP and PP levels are higher and SBP-profile is different in patients with diabetic compared to those with nondiabetic CKD. Systolic and diastolic BPV are also higher in diabetics. These findings may signify a higher cardiovascular risk for patients with both DM and CKD compared to patients with CKD alone, through higher BP levels and BPV.

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Blood pressure variability increases with advancing chronic kidney disease stage

Abstract: An increase in short-term SBP-variability was present with advancing CKD stages in a large cohort. This increased SBP-variability may be involved in the sharp elevation of cardiovascular risk with worsening renal function.

Cited by 78 publications

References 45 publications

Blood pressure variability: clinical relevance and application

Blood pressure variability: clinical relevance and application

Vascular calcification is associated with Wnt‐signaling pathway and blood pressure variability in chronic kidney disease rats

Ambulatory Blood Pressure Trajectories and Blood Pressure Variability in Diabetic and Non-Diabetic Chronic Kidney Disease

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