The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Sinha, Arjun; Agarwal, Rajiv

doi:10.1053/j.ackd.2015.01.003

Cited by 33 publications

(29 citation statements)

References 72 publications

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“…Non-/reverse-dipping was also shown to be a risk factor for cardiovascular events and correlated with markers for cardiovascular events in CKD patients (101415162829). Multiple factors cause suppressed nighttime BP decrease, such as older age, race, autonomic dysfunction, abnormal sleep-wake cycle, and sodium sensitivity (30). In addition, Feldstein et al (31) reported that non-dippers were associated with elevated serum Ca in elderly essential hypertensive patients with mild-to-moderate CKD, and Kanbay et al (32) reported that the non-dipper clinical profile is related to serum Ca, P, and PTH in hypertensive patients with normal renal function.…”

Section: Discussionmentioning

confidence: 99%

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

Chin

Ahn

et al. 2017

J Korean Med Sci

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Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1–G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1–2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1–2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin.

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Section: Discussionmentioning

confidence: 99%

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

Chin

Ahn

et al. 2017

J Korean Med Sci

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“…Blood pressure values obtained by ABPM, better than casual measurements, correlate with organ damage of hypertension [11][12][13]. With www.ah.viamedica.pl the twenty-four hour blood pressure monitoring it has become possible to analyse the circadian blood pressure profile.…”

Section: Discussionmentioning

confidence: 99%

“…Data from recent years show that patients with hypertension characterized as "non-dippers" are burdened with a higher risk of cardiovascular events [13]. Evaluation of circadian blood pressure profile may identify CKD patients at high risk of complications of the cardiovascular system.…”

Section: Discussionmentioning

confidence: 99%

Circadian blood pressure profile in patients with chronic kidney disease stage 1-3

Pluta

Stróżecki

Manitius

2015

Arterial Hypertension

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SummaryBackground The population of patients with chronic kidney disease (CKD) is prone to high cardiovascular morbidity and mortality. Aberrant circadian pattern of blood pressure is associated with increase cardiovascular risk. The study investigated circadian blood pressure profile in patients with early stages of CKD. Material and methodsThe study included 90 patients with CKD stage 1-3, aged 34-79 years and 30 healthy volunteers as control group. All patients underwent ambulatory blood pressure monitoring (ABPM). Patient was classified as "dipper" if relative decreases in SBP and DBP at night was at least 10%. If the drop the SBP or DBP was less than 10% patient was classified as "non-dipper". Results Hypertension was present in 78.9% of patients with CKD stage 1-3. "Non-dipper" profile was found in 59 (66%) of the surveyed patients with CKD, namely in 16 (53%) in CKD stage 1, 23 (70%) in CKD stage 2, and 20 (74%) in CKD stage 3. "Non-dipper" profile was observed in 9 (30%) of control patients. In the whole study population (n = 120) significant positive correlation was found between % drop in SBP and eGFR (r = 0.25; p < 0.01). There was no significant correlation between % drop in SBP and eGFR (r = 0.12; p = 0.26) in 90 CKD patients. There was statistically significant negative correlation between % drop in SBP and age (r = -0.25; p < 0.05) and BMI (r = -0.24; p < 0.05). Conclusions "Non-dipper" profile is a common finding among patients with early stages of CKD and may be associated with a higher cardiovascular risk. ABPM should be a standard procedure in patients with CKD, even in early stages of the disease. key words: chronic kidney disease, dipper, non-dipper, circadian blood pressure profile

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“…Kod zdravih osoba, KP pokazuje noćni pad od približno 10-20%, koji je regulisan delovanjem nekoliko faktora uključujući diurnalne varijacije u autonomnoj funkciji nervnog sistema, ekskreciju soli i RAAS. Poremećena regulacija ovih sistema u HBB vodi "non-dipping-u" ili čak porastu KP u toku noći, koji je udružen sa povećanim KV morbiditetom i mortalitetom i rizikom progresije HBB [55]. Adekvatno sniženje KP redukuje proteinuriju čime usporava opadanje JGF i smanjuje rizik KV događaja.…”

Section: Farmakološke Intervencije Antihipertenzivna Terapijaunclassified

Pathophysiological mechanisms of cardiovascular disease in chronic kidney disease and possibilities of prevention

Tirmenštajn-Janković¹

2019

Timočki medicinski glasnik

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Sažetak: Kardiovaskularne bolesti (KVB) su vrlo česta komplikacija i glavni uzrok morbiditeta i mortaliteta kod bolesnika sa uznapredovalom hroničnom bubrežnom bolešću (HBB). Brojne epidemiološke studije su potvrdile ovu povezanost, a kliničke i eksperimentalne studije su proširile postojeća saznanja o patofiziološkim mehanizmima uključenim u ove procese. Tradicionalni faktori rizika za KVB su istovremeno i faktori rizika za HBB, te su stoga visoko zastupljeni u populaciji bolesnika sa HBB. Međutim, tokom progresije HBB javljaju se i netradicionalni faktori rizika specifični za uremiju, kao što su albuminurija, anemija, hiperparatireoidizam, metabolička bolest kostiju, hiperhomocistinemija, malnutricija, dislipidemija, inflamacija, endotelna disfunkcija i oksidativni stres. Krajnji rezultat aditivnog delovanja ovih faktora je ubrzani razvoj ateroskleroze što dalje ubrzava progresiju i KVB i HBB. Uprkos dostupnosti efikasnih tretmana, KVB je još uvek nedovoljno dijagnostikovana i lečena u ovoj grupi bolesnika. Bolesnike sa HBB bi stoga trebalo prepoznati kao grupu visokog KV rizika. Dodatne randomizovane, kontrolisane studije su neophodne u istraživanju preventivnih strategija i proceni terapijskih pristupa kod bolesnika sa različitim stepenima renalne disfunkcije. Ključne reči: kardiovaskularna bolest, hronična bubrežna bolest, patofiziološki mehanizmi, prevencija. Summary: Cardiovascular disease (CVD) is a very common complication and major cause of morbidity and mortality in patients with advanced chronic kidney disease (CKD). Since the first description of the association between CKD and CVD, numerous epidemiological studies have confirmed, and clinical and experimental studies have further expanded the existing knowledge of the pathophysiological mechanisms involved in these processes. Traditional risk factors for CVD are at the same time the risk factors for CKD, and are therefore highly represented in the CKD population. However, during CKD progression, non-traditional uremia-specific risk factors also occur, such as albuminuria, anemia, hyperparathyroidism, bone metabolic disease, hyperchomocystinaemia, malnutrition, dyslipidemia, inflammation, endothelial dysfunction, and oxidative stress. The ultimate result of the additive effect of these factors is the accelerated development of atherosclerosis that substantially increases the burden of CVD and accelerates the progression of CKD. Despite the availability of effective treatments, CVD is still underdiagnosed and undertreated in this group of patients. Patients with CKD should therefore be recognized as a group at high CV risk. Additional randomized, controlled trials are urgently needed in researching preventive strategies and assessing therapeutic approaches in patients with varying degrees of renal dysfunction.

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The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

Cited by 33 publications

References 72 publications

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

Circadian blood pressure profile in patients with chronic kidney disease stage 1-3

Pathophysiological mechanisms of cardiovascular disease in chronic kidney disease and possibilities of prevention

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