Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population

Yano, Yuichiro; Fujimoto, Shouichi; Kramer, Holly; Sato, Yuji; Konta, Tsuneo; Iseki, Kunitoshi; Iseki, Chiho; Moriyama, Toshiki; Yamagata, Kunihiro; Tsuruya, Kazuhiko; Narita, Ichiei; Kondo, Masahide; Kimura, Kenjiro; Asahi, Koichi; Kurahashi, Issei; Ohashi, Yasuo; Watanabe, Tsuyoshi

doi:10.1161/hypertensionaha.115.05472

Cited by 57 publications

(47 citation statements)

References 31 publications

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“…11-13, 28, 29 The associations between obesity (defined by BMI) and BP variability, have been inconsistent. 14-16 In our study, participants with higher BMI had higher long-term ARV SBP with a modest increase in mean SBP across BMIs, whereas an increase in mean SBP with less variable long-term ARV SBP was observed with increasing visceral adiposity. Regional fat distribution may therefore be a determinant of individual BP level and variability, independent of BMI, which would partially explain the complex associations of obesity with BP variability.…”

Section: Discussionmentioning

confidence: 45%

Regional Fat Distribution and Blood Pressure Level and Variability

et al. 2016

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Our aim was to investigate the associations of regional fat distribution with home and office blood pressure (BP) levels and variability. Participants in the Dallas Heart Study, a multiethnic cohort, underwent five BP measurements on three occasions over 5 months (two in-home and one in-office) and quantification of visceral (VAT), abdominal subcutaneous adipose tissue (SAT), and liver fat by MRI, and lower body subcutaneous fat by dual x-ray absorptiometry. The relation of regional adiposity with short-term (within-visit) and long-term (over all visits) mean BP and average real variability (ARV) was assessed with multivariable linear regression. 2,595 participants mean age 44 years; 54% women, 48% black; and mean BMI 29 kg/m2 were included. Mean SBP/DBP was 127/79mmHg and ARVSBP was 9.8mmHg over 3 visits. In multivariable-adjusted models, higher amount of VAT was associated with higher short-term (both home and office) and long-term mean SBP (β[SE]: 1.9[0.5], 2.7[0.5], and 2.1[0.5], respectively, all P<0.001), and with lower long-term ARVSBP (β[SE]: -0.5[0.2], P<0.05). In contrast, lower body fat was associated with lower short-term home and long-term mean BP (β[SE]: -0.30[0.13] and -0.24[0.1], respectively, both P<0.05). Neither SAT or liver fat were associated with BP levels or variability. In conclusion, excess visceral fat was associated with persistently higher short- and long-term mean BP level and with lower long-term BP variability whereas lower body fat was associated with lower short- and long-term mean BP. Persistently elevated BP, coupled with lower variability, may partially explain increased risk for cardiac hypertrophy and failure related to visceral adiposity.

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Section: Discussionmentioning

confidence: 45%

Regional Fat Distribution and Blood Pressure Level and Variability

et al. 2016

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“…Increased SBPV was also linked to adverse renal outcomes. One SD higher SBPV was associated with 15% (95% CI: 11% to 20%) higher incidence in renal dysfunction defined as new proteinuria on dipstick, eGFR <60 ml/min1.73 m 2 , or rapid eGFR decline (≥3 ml/min/1.73 m 2 per year) in a nationwide Japanese study including 48,587 participants (37). A post hoc analysis of the Irbesartan Diabetic Nephropathy Trial and the Reduction of End Points in Non-Insulin-Dependent Diabetes with the Angiotensin II Antagonist Losartan study that included 2,739 individuals with baseline nephropathy demonstrated that greater baseline VVV in SBP was associated with higher risk of the composite outcome of doubling serum creatinine, ESRD, or death, but not with cardiovascular outcomes (38).…”

Section: Discussionmentioning

confidence: 99%

Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease

Gosmanova

Mikkelsen

Molnar

et al. 2016

Journal of the American College of Cardiology

242

180

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BACKGROUND Intraindividual blood pressure (BP) fluctuates dynamically over time. Previous studies suggested an adverse link between greater visit-to-visit variability (VVV) in systolic blood pressure (SBP) and various outcomes. However, these studies have significant limitations, such as a small size, inclusion of selected populations, and restricted outcomes. OBJECTIVES We investigated the association of increased VVV and all-cause mortality, cardiovascular events, and end-stage renal disease (ESRD) in a large cohort of U.S. veterans. METHODS From among 3,285,684 U.S. veterans with and without hypertension and normal estimated glomerular filtration rates (eGFR) during 2005 and 2006, we identified 2,865,157 patients who had 8 or more outpatient BP measurements. SBP variability (SBPV) was measured using the SD of all SBP values (normally distributed) in 1 individual. Associations of SD quartiles (<10.3, 10.3 to 12.7, 12.7 to 15.6, and ≥15.6 mm Hg) with all-cause mortality, incident coronary heart disease (CHD), stroke, and ESRD was examined using Cox models adjusted for sociodemographic characteristics, baseline eGFR, comorbidities, body mass index, SBP, diastolic BP, and antihypertensive medication use. RESULTS Several sociodemographic variables (older age, male sex, African-American race, divorced or widowed status) and clinical characteristics (lower baseline eGFR, higher SBP and DBP), and comorbidities (presence of diabetes, hypertension, cardiovascular disease, and lung disease) were all associated with higher intraindividual SBPV. The multivariable adjusted hazard ratios and 95% confidence intervals for SD quartiles 2 through 4 (compared to the first quartile) associated with all-cause mortality, CHD, stroke, and ESRD were incrementally higher. CONCLUSIONS Higher SBPV in individuals with and without hypertension was associated with increased risks of all-cause mortality, CHD, stroke, and ESRD. Further studies are needed to determine interventions that can lower SBPV and their impact on adverse health outcomes.

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“…Most recently, Yano et al (13) showed that higher SBP variability was associated with the development of proteinuria or eGFR,60 ml/min per 1.73 m 2 among 48,587 Japanese adults without CKD or diabetes. However, studies showing a higher risk for advanced renal disease, such as ESRD, have been restricted to persons with diabetes.…”

Section: Discussionmentioning

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%

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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Long-Term Blood Pressure Variability, New-Onset Diabetes Mellitus, and New-Onset Chronic Kidney Disease in the Japanese General Population

Cited by 57 publications

References 31 publications

Regional Fat Distribution and Blood Pressure Level and Variability

Regional Fat Distribution and Blood Pressure Level and Variability

Association of Systolic Blood Pressure Variability With Mortality, Coronary Heart Disease, Stroke, and Renal Disease

Visit-to-Visit Variability of BP and CKD Outcomes

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