The Relationship Between Blood Pressure Variability And Renal Progression In Hypertensive Patients With Chronic Kidney Disease

Abstract

Objective: To evaluate the effect of 24 hour systolic blood pressure (SBP) and diastolic blood pressure (DBP) variability (BPV) on renal progression in hypertensive patients with chronic kidney disease (CKD) Methods: A total 59 hypertensive patients (mean age: 54.2±14.6 years, 50.8% male) with CKD who underwent 24 hours ambulatory blood pressure measurement (ABPM) were included. Data on SBP, DBP, BPV coefficients (VC) for SBP (SBP-CV) and DBP (DBP-CV) were recorded. A decrease in e-GFR of <5 ml/min/year was considered as normal renal progression and a decrease in ≥5 ml/min/year was considered as rapid renal progression. Results: Overall, 40.6% of the patients had uncontrolled HT, while 45.8% had non-dipper pattern. Mean±SD daytime and night-time SBP and SBP-VC values were 135.3±17.9 mmHg, 128.6±23.0 mmHg, 11.7±2.8 and 9.5±3.6, respectively. Mean±SD daytime and nigh-time DBP and DBP-VC values were 84.5±13.4 mmHg, 77.2±16.1 mmHg, 13.8±3.8 and 12.0±3.7, respectively. Rapid renal progression was detected in 25.4% of patients with no significant difference in daytime, night-time and total SBP, SBP-VC, DBP and DBP-VC values between patients with rapid vs. natural renal progression. The regression analysis adjusted for age, gender, presence of DM, baseline e-GFR and dipping status revealed no significant impact of SBP-VC and DBP-VC in predicting rapid progression (p> 0.05). Conclusion: In conclusion, our finding revealed no significant association between BPV and renal progression in hypertensive patients with CKD. Larger scale prospective, randomized controlled trials with longer follow-up are needed to clarify this issue.

Change in GFR in relation to pulse rate, dipping blood pressure, anti-hypertensives, NLR and PLR in patients with chronic kidney disease

“…Our findings revealed no association between dipping systolic or diastolic BP and GFR decline from baseline. Likewise, we have previously reported in 186 adult patients with CKD and HT that the dipper HT pattern was prevalent (45.8%) in them, possibly concerning the presence of severe proteinuria and no significant association of BP variability or non-dipper HT pattern with renal progression (21).…”

“…In fact, our findings on the significant age-dependency of GFR decline seem notable given the reported association of age with SBP or DBP variability in the past studies (21,22,28). In addition, the association of diuretic treatment with GFR change from baseline in our study also seems to support the likelihood of the different impacts of different anti-hypertensive medications on BP variability (i.e., a decline in variability with calcium channel blockers and nonloop diuretics and an increase in variability with ACE inhibitors) (29).…”

“…Although the non-dipper HT pattern is considered to be more prevalent in CKD patients as a known indicator of rapid end-organ damage, the direct interaction between non-dipper HT and renal progression remains unclear (20,21). Past studies based on 24-h ABPM recording revealed the likelihood of increased DBP variability associated with better renal outcomes (13) and no significant impact of 24-hour systolic and diastolic BP variability on the progression of CKD (21)(22)(23). Our findings revealed no association between dipping systolic or diastolic BP and GFR decline from baseline.…”

“…Moreover, 1-year data from the APrODiTe-2 study with 400 CKD patients revealed the association of good BP control and the dipper BP pattern with subtler eGFR and proteinuria changes (25). Indeed, given the association of non-dipping BP profile and nocturnal hypertension with hypertension-mediated organ damage in CKD patients, ABPM is suggested to be more extensively used for applying individual risk assessment and personalized anti-hypertensive treatment in CKD patients (26), and the daily BP variability on 24-hour ABPM rather than visit-to-visit BP variability is considered more valuable in reflecting the renal survival (5,21). Notably, a past study with 10271 hypertensive patients (3227 with CKD) from the…”