Reversed Dipper Blood-Pressure Pattern Is Closely Related to Severe Renal and Cardiovascular Damage in Patients with Chronic Kidney Disease

Wang, Cheng; Zhang, Jun; Liu, Xun; Li, Cuicui; Ye, Zengchun; Peng, Hui; Chen, Zhujiang; Lou, Tanqi

doi:10.1371/journal.pone.0055419

Cited by 82 publications

(88 citation statements)

References 24 publications

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“…The presence or absence of antihypertensive treatment did not contribute to change the BP pattern described here. Consistent with our results, several previous studies described an association between albuminuria and circadian ambulatory BP in patients with diabetes or CKD (13)(14)(15)(16)(17). However, unlike our study, most of the previous studies had relatively small sample sizes (a few hundred patients), and, more importantly, they focused on nighttime nondipping or isolated nocturnal hypertension, whereas we used nighttime BP as a continuous variable, allowing for the quantification of nocturnal BP differences across albuminuria groups.…”

Section: Discussionsupporting

confidence: 82%

“…Several studies (13)(14)(15)(16)(17) have associated the circadian rhythm of BP to proteinuria/albuminuria in patients with diabetes and/or CKD. Additionally, previous data from our group showed that high albuminuria (30-300 mg/g creatinine) is associated with nighttime systolic BP (SBP) in treated and untreated patients with hypertension and in those with resistant hypertension (18,19).…”

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confidence: 99%

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Association Between High and Very High Albuminuria and Nighttime Blood Pressure: Influence of Diabetes and Chronic Kidney Disease

et al. 2016

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OBJECTIVENighttime blood pressure (BP) and albuminuria are two important and independent predictors of cardiovascular morbidity and mortality. Here, we examined the quantitative differences in nighttime systolic BP (SBP) across albuminuria levels in patients with and without diabetes and chronic kidney disease. RESEARCH DESIGN AND METHODSA total of 16,546 patients from the Spanish Ambulatory Blood Pressure Monitoring Registry cohort (mean age 59.6 years, 54.9% men) were analyzed. Patients were classified according to estimated glomerular filtration rate (eGFR), as ‡60 or <60 mL/min/1.73 m 2 (low eGFR), and urine albumin-to-creatinine ratio, as normoalbuminuria (<30 mg/g), high albuminuria (30-300 mg/g), or very high albuminuria (>300 mg/g). Office and 24-h BP were determined with standardized methods and conditions. RESULTSHigh albuminuria was associated with a statistically significant and clinically substantial higher nighttime SBP (6.8 mmHg higher than with normoalbuminuria, P < 0.001). This association was particularly striking at very high albuminuria among patients with diabetes and low eGFR (16.5 mmHg, P < 0.001). Generalized linear models showed that after full adjustment for demographic, lifestyles, and clinical characteristics, nighttime SBP was 4.8 mmHg higher in patients with high albuminuria than in those with normoalbuminuria (P < 0.001), and patients with very high albuminuria had a 6.1 mmHg greater nighttime SBP than those with high albuminuria (P < 0.001). These differences were 3.8 and 3.1 mmHg, respectively, among patients without diabetes, and 6.5 and 8 mmHg among patients with diabetes (P < 0.001). CONCLUSIONSAlbuminuria in hypertensive patients is accompanied by quantitatively striking higher nighttime SBP, particularly in those with diabetes with very high albuminuria and low eGFR.

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Section: Discussionsupporting

confidence: 82%

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confidence: 99%

Association Between High and Very High Albuminuria and Nighttime Blood Pressure: Influence of Diabetes and Chronic Kidney Disease

et al. 2016

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“…Our previous study suggested that age is independently correlated with the estimated glomerular filtration rate (eGFR), proteinuria and reverse dipper pattern of blood pressure in Chinese CKD patients [17]. We believe that age could play a key part in CKD and CVD based on previous data.…”

Section: Introductionmentioning

confidence: 89%

Disparate assessment of clinic blood pressure and ambulatory blood pressure in differently aged patients with chronic kidney disease

Wang¹,

Gong²,

Zhang³

et al. 2015

International Journal of Cardiology

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“…This is in contrast to an investigation that found a cross-sectional association of dipping an LV mass. 23 Which component of ambulatory BP should be used for the diagnosis of MUCH is a matter of debate. The conventional definition uses the awake ambulatory BP for making a diagnosis of MUCH.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Study of Left Ventricular Mass Growth

Agarwal

2016

Hypertension

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; CKD is associated with a large and disproportionate burden of cardiovascular morbidity and mortality. 4 CKD rivals diabetes mellitus as a coronary risk equivalent in veterans. 5 Established risk factors for cardiovascular disease include left ventricular (LV) mass and blood pressure (BP). 6,7 Although both LV mass and BP are powerful cardiovascular risk factors, little information is available on how LV mass evolves among people with CKD. 8,9 The cross-sectional relationship between LV mass and BP is well recognized but among those with CKD how LV mass changes over time and how BP predicts this change remains poorly understood.Accumulating evidence suggests that BP measurements made outside the clinic may provide prognostically superior information. [10][11][12][13] However, the comparative value of BP obtained in the clinic and that obtained using 24-hour ambulatory BP in assessing LV mass index is unclear. People receiving antihypertensive therapy who have hypertension out-of-office but have normal BP in the clinic are said to have masked uncontrolled hypertension (MUCH).14 An earlier report from my group has reported that the prevalence of MUCH is strongly dependent on the level of clinic BP. 15Thus, those who repeatedly have a low clinic systolic BP (<110 mm Hg) are unlikely to have MUCH. However, among those with usual clinic BP of 130 to 139 mm Hg, MUCH is prevalent in 2 of 3 and those with usual clinic BP of 120 to 129 mm Hg, MUCH is prevalent in 1 of 3. Whether MUCH diagnosed by ambulatory BP monitoring is associated with an increased LV mass is unknown.In this study, I explored the trajectory and pattern of growth of LV mass, clinic systolic BP, 24-hour ambulatory BP, including sleep and awake BP. Whether ambulatory BP measurement is superior to clinic BP was explored by asking the following questions: (1) compared with clinic BP, is there a stronger association between target organ damage and ambulatory BP; (2) does ambulatory BP-diagnosed MUCH associate with LV mass index and if so by which definition (24-hour, awake or sleep ambulatory BP); and (3) compared with clinic BP, is there an incremental value of ambulatory BP (24-hour, awake, or sleep) in detecting and predicting target organ damage.Abstract-Left ventricular (LV) hypertrophy is an established cardiovascular risk factor, yet little is known about its trajectory in people with chronic kidney disease. The goal of this prospective research study was to describe the trajectory of LV mass index, its relationship with blood pressure (BP), and specifically to compare the relationship of BP measured in the clinic and 24-hour ambulatory BP monitoring with LV mass index. Among 274 veterans with chronic kidney disease followed for over ≤4 years, the rate of growth of log LV mass index was inversely related to baseline LV mass index; it was rapid in the first 2 years, and plateaued subsequently. Systolic BP also significantly increased, but linearly, 1.7 mm Hg/y by clinic measurements and 1.8 mm Hg/y by 24-hour ambulatory BP. Cross-sectional and lon...

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Reversed Dipper Blood-Pressure Pattern Is Closely Related to Severe Renal and Cardiovascular Damage in Patients with Chronic Kidney Disease

Cited by 82 publications

References 24 publications

Association Between High and Very High Albuminuria and Nighttime Blood Pressure: Influence of Diabetes and Chronic Kidney Disease

Association Between High and Very High Albuminuria and Nighttime Blood Pressure: Influence of Diabetes and Chronic Kidney Disease

Disparate assessment of clinic blood pressure and ambulatory blood pressure in differently aged patients with chronic kidney disease

Longitudinal Study of Left Ventricular Mass Growth

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