Short-term blood pressure variability and outcomes in non-dialysis chronic kidney disease

Abstract

BackgroundBlood pressure variability (BPV) is associated with cardiovascular and all-cause mortality, and has been demonstrated in dialysis patients, but has been poorly studied and remains controversial in non-dialysis chronic kidney disease (CKD) patients. We investigated the effect of short-term BPV on prognosis in this population.MethodsA total of 245 stage 1–4 CKD patients with 24-h ambulatory blood pressure recordings were recruited. BPV was evaluated by standard deviation, coefficient of variation, and variation independent of the mean, respectively. All subjects were followed up to the composite end-point event or until January 15, 2020. Patients were divided into two groups based on 24-h median variation independent of the mean, and demographics, laboratory indicators and echocardiogram results were compared. Logistic regression was used to analyze the risk factors for increased BPV. Multivariate Cox regression and Kaplan-Meier survival analysis were used to explore the relationship between BPV and renal prognosis and major cardiovascular events.ResultsThe mean age was 42.07 ± 12.66 years, with 141 males (57.55%). Multivariate Logistic regression analysis showed that high BMI (OR 1.110, P = 0.017), hyperkalemia (OR 2.227, P = 0.040), increased left ventricular end-diastolic diameter (OR 1.103, P = 0.010) and hypertension (OR 2.525, P = 0.002) were independent risk factors for high BPV. Kaplan-Meier survival analysis showed that renal and cardiovascular outcomes were better in the low BPV group than in the high BPV group (P = 0.006; P = 0.002). After adjusting for age, sex and traditional kidney related risk factors, BPV were not independently associated with renal outcomes. High BPV (HR 4.662, P = 0.017) was the main independent risk factor for major cardiovascular events in CKD.ConclusionsIn non-dialysis CKD, short-term BPV was associated with major cardiovascular disease but not renal progression. BMI, hypertension, potassium balance, and left ventricular end-diastolic diameter influenced short-term BPV.

Association between oral microbial nitrate metabolism and poor prognosis in acute ischemic stroke patients with a history of hypertension

“…Blood pressure variability plays a crucial role in organ perfusion, and its correlation with prognosis has been observed in various diseases [ 27–33 ], including AIS [ 34 ]. Studies have indicated that following intravenous thrombolysis, there is an increase in blood pressure variability within the first 24 h, which can contribute to early and severe bleeding conversion in intravenous thrombolysis patients, thereby elevating the risk of poor prognosis [ 35 ].…”

Variability: The Hallmark of Blood Pressure Measurement – Types, Assessment and Prognostic Significance

“…Wang G et al, in their study of 245 non-dialyzed patients of renal failure (grade 1-4), found a correlation of high BPV (assessed by SD, CV, and VIM) with the progression of renal disease (seen only in unadjusted model and not in fully adjusted model) and cardiovascular disease but not with total mortality. 43 They found hyperkalemia, LV end-diastolic diameter, hypertension, and BMI as markers of high BPV.…”