Time rate of blood pressure variation is associated with impaired renal function in hypertensive patients

Manios, Efstathios; Tsagalis, Georgios; Tsivgoulis, Georgios; Barlas, Gerassimos; Koroboki, Eleni; Michas, F.; Alexaki, E; Vemmos, Konstantinos; Zakopoulos, Nikolaos

doi:10.1097/hjh.0b013e328330a94f

Cited by 85 publications

(65 citation statements)

References 28 publications

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“…Moreover, despite the increasing evidence for a correlation between short term BPV and the development, progression and severity of cardiac, vascular and renal organ damage [7], the effect of different antihypertensive drugs on short term BPV is still unclear [8, 9]. …”

Section: Introductionmentioning

confidence: 99%

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

Pengo

Ioratti

Bisogni

et al. 2017

Kidney Blood Press Res

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Background/Aims: In chronic kidney disease (CKD) patients blood pressure variability (BPV) is associated with poor outcome. Sleep disturbances alter BP profiles in hypertensives but their influence on BPV in CKD patients is unknown. We screened a cohort of CKD/ESRD patients to investigate whether sleep quality impacts on BPV. Methods: Consecutive CKD patients’ sleep quality was assessed using validated questionnaires (Epworth Sleepiness Scale-ESS); International Restless legs scale-IRLS; Functional Outcomes of Sleep Questionnaire-FOSQ: Insomnia Severity Index-ISI; STOP-Bang). All patients underwent ambulatory blood pressure measurement. Results: 104 out of 143 enrolled patients (78.32% stage-3 CKD; 10.49% Stage-4; 11.19% Stage-5; 6.99% ESRD-under dialysis) completed all the questionnaires. 95.8% were hypertensives, 70% were non-dippers and 27.8% had resistant hypertension. STOP-Bang>4 proved sleep disorders in 84.84% of patients. Patients with IRLS>10 had greater diastolic nocturnal standard deviation (DNSD) and a trend (p=0.05) for systolic nocturnal SD (SNSD). Patients with ISI>14 had greater SNSD and in 28.8% FOSQ showed severely impaired sleep quality. Their systolic nocturnal BPV was significantly greater. ISI was independently associated with SNSD. FOSQ and diastolic nocturnal BPV were negatively correlated at the bivariate analysis and FOSQ independently predicts systolic nocturnal BPV at multivariate regression analysis. Conclusions: In CKD patients impaired sleep quality increases BPV, might contribute to their disease progression and worsen prognosis. Searching for sleep problems in CKD patients could help planning their treatment of sleep problems contributing to CV risk reduction. Our data provide the rationale working hypothesis for the need of studies with larger number of patients aimed to demonstrate improved outcome of CKD progression and CV risk with the treatment also of sleep disorders.

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Section: Introductionmentioning

confidence: 99%

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

Pengo

Ioratti

Bisogni

et al. 2017

Kidney Blood Press Res

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“…69 From a prognostic perspective, assessment of these indices may be relevant on the background of the evidence supporting the association between increasing values of short-term BPV within 24 hours and an increased prevalence and progression of cardiac, vascular, and renal target organ damage, 4,13-17 cardiovascular events, 3,[6][7][8]12,[18][19][20][21] and cardiovascular mortality. 5,6,8,12 Cross-sectional analyses in untreated essential hypertensives have found an increased short-term BPV to be directly correlated with urinary albumin excretion 16 and inversely correlated with glomerular filtration rate, 17 even after accounting for differences in average BP levels. Although the additional predictive value of an increased BPV seems to be marginal when accounting for the impact of average BP levels in subjects at low-to-moderate cardiovascular risk, the predictive value of an increased BPV has been shown to add significantly in particular to prediction of cardiovascular complications over and beyond the impact of average BP levels in subjects at high cardiovascular risk, such as hypertensive subjects with CKD.…”

Section: Abpm In the Assessment Of Short-term Bpv And Its Clinical Immentioning

confidence: 99%

Hypertension in Chronic Kidney Disease Part 2

et al. 2016

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Blood pressure (BP) is characterized by high variability, including changes beat-to-beat (very short term), within 24 hours (short term), from day to day (midterm), and between visits spaced by weeks, months, seasons, and even years (long term). These variations can be estimated by means of continuous beat-to-beat BP recordings, repeated conventional office BP measures, 24-hour ambulatory BP monitoring (ABPM), or home BP monitoring (HBPM) over longer time windows (Table). A main advantage of ABPM over other BP measurement techniques is represented by its ability to track BP changes occurring in daily life conditions and during 24 hours, thus allowing assessment of overall BP variability (BPV) as well as identification of its specific components, such as nocturnal hypertension and altered day-to-night BP profiles (ie, morning BP rise, nondipping pattern of BP) which become manifest early in the course of chronic kidney disease (CKD). These alterations are even more significant in subjects with end-stage renal disease (ESRD) mainly, but not exclusively, because of the marked reduction in intravascular volume immediately after hemodialysis followed by the progressive increase in volemia throughout the interdialytic period, 2 combined with an enhanced sympathetic activity. The higher frequency of alterations in 24-hour BP profiles and BPV in subjects with CKD and in those with ESRD not only makes a proper assessment and achievement of BP control more difficult in these subjects but may be prognostically relevant on the background of the evidence from longitudinal and observational studies indicating that increased BPV may predict the development of cardiovascular and renal disease, over and above the contribution of elevated mean BP levels per se 3-11 ( Figure 1). The purpose of this review is to address the currently available evidence on the role of ABPM and HBPM for the assessment and management of alterations in circadian BP profiles and in BPV in patients with CKD. Mechanisms of BPVIn physiological conditions, BP fluctuations occurring on a beat-by-beat basis and within the 24 hours may represent a homeostatic response of neural (ie, central sympathetic drive and its reflex modulation by arterial and cardiopulmonary reflexes), humoral (catecholamines, insulin, angiotensin II, bradykinin, endothelin-1, and nitric oxide), vascular (ie, elastic properties of arteries), and rheological mechanisms (ie, blood viscosity) to environmental (weather changes), behavioral (ie, physical activity, sleep, postural changes), and emotional (ie, psychological stress) stimuli.

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“…explored the relationship between short-term BPV/withinvisit BPV and markers of early renal damage, with conflicting results. (10,(14)(15)(16)(17)(18)(19) It could be hypothesized that an enhanced withinvisit BPV in patients with early renal abnormalities may help to explain in part their increased CV risk.…”

Section: Introductionmentioning

confidence: 99%

Relationship Between Within-Visit Blood Pressure Variability and Kidney Function in Patients with Arterial Hypertension

Kravchenko¹,

Chernykh²,

Budnevsky³

et al. 2017

IJBM

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The main purpose of this study was to investigate the features of within-visit blood pressure variability (BPV) in patients with arterial hypertension (AH) and to assess the relationship of those features to impaired renal filtration.Material and Methods: The study included 120 patients with AH Stages I and II (ESH/ESC, 2013): 58(48.3%) men and 62(51.7%) women aged from 22 to 73 years (mean age 58.7±15 years). Average duration of AH was 15.0±6.7 years. BP was measured three times at 2-minute intervals during one visit. Within-visit BPV was evaluated by the presence of an absolute difference (AD) between any two readings of three SBP measurements of more than 5 mmHg. All patients underwent a comprehensive examination, which included blood and urine tests, kidney ultrasound, assessment of blood levels of creatinine and TnT, and calculation of GFR.Results: Depending on the response of BP to repeated measurements, three types of BPV were identified. A prognostically unfavorable type of BPV, which is characterized by SBP-AD > 5 mmHg between the third and first measurements, was identified. Patients of this group had the lowest eGFR value that indicates more pronounced renal damage, and, as a consequence, worse prognosis. Also in these patients, there was an increase in TnT level, which is a predictor of the development of adverse cardiovascular complications. (International Journal of Biomedicine. 2017;7(2):91-95.)

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Time rate of blood pressure variation is associated with impaired renal function in hypertensive patients

Abstract: The 24-h rate of SBP variation is independently associated with impaired renal function. Target-organ damage in hypertensive patients, in addition to BP levels, dipping status and BP variability, may also be related to a steeper rate of BP fluctuations.

Cited by 85 publications

References 28 publications

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

In Patients with Chronic Kidney Disease Short Term Blood Pressure Variability is Associated with the Presence and Severity of Sleep Disorders

Hypertension in Chronic Kidney Disease Part 2

Relationship Between Within-Visit Blood Pressure Variability and Kidney Function in Patients with Arterial Hypertension

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