Short-termblood pressure variability in nondialysis chronic kidney disease patients: correlates and prognostic role on the progression of renal disease

被引：34

作者：

Borrelli, Silvio ^{[1
]}

Garofalo, Carlo ^{[1
]}

Mallamaci, Francesca ^{[2
]}

Tripepi, Giovanni ^{[2
]}

Stanzione, Giovanna ^{[1
]}

Provenzano, Michele ^{[1
]}

Conte, Giuseppe ^{[1
]}

De Nicola, Luca ^{[1
]}

Zoccali, Carmine ^{[2
]}

Minutolo, Roberto ^{[1
]}

机构：

[1] Univ Campania Luigi Vanvitelli, Dept Sci Med Chirurg Neurol Metab & Invecchiament, Div Nephrol, Via M Longo 50, I-80138 Naples, Italy

[2] CNR, IBIM, Clin Epidemiol & Physiopathol Renal Dis & Hyperte, Reggio Di Calabria, Italy

来源：

JOURNAL OF HYPERTENSION | 2018年 / 36卷 / 12期

关键词：

ambulatory blood pressure monitoring; blood pressure variability; chronic kidney disease; renal risk; AMBULATORY BLOOD-PRESSURE; CROSS-SECTIONAL ANALYSIS; WHITE-COAT HYPERTENSION; PRACTICE GUIDELINES; EUROPEAN-SOCIETY; ORGAN DAMAGE; RECORDINGS; ASSOCIATION; OUTCOMES; CKD;

D O I：

10.1097/HJH.0000000000001825

中图分类号：

R6 [外科学];

学科分类号：

1002 ; 100210 ;

摘要：

Objective: In chronic kidney disease (CKD), few cross-sectional studies evidenced an association between short-term BP variability (BPV) derived from ambulatory blood pressure (ABP) monitoring and renal damage. However, no study has evaluated the association of short-term BPV with the risk of CKD progression. Methods: We performed a cohort study to assess the correlates and the predictive value for incident renal outcomes of short-term BPV in hypertensive patients with CKD stage G1-5. As measures of short-term BPV, we considered the weighted SD (W-SD), and the coefficient of variation of SBP (CV-24-h SBP). Primary outcome was a composite endpoint of ESRD (chronic dialysis or transplantation) or GFR decline of at least 50%. Results: We included 465 patients (63.5 +/- 14.2 years; 54.7% men; eGFR: 44 +/- 22 ml/min per 1.73m(2); proteinuria: 0.2 [0.1-0.9] g/day); W-SD, CV-24-h SBP and 24 h SBP were 12.5 +/- 3.3mmHg, 11.1 +/- 2.8% and 127 +/- 16mmHg, respectively. W-SD was independently associated with older age, history of cardiovascular disease, diagnosis of diabetic, hypertensive and polycystic nephropathy, and higher 24 h SBP whereas no association with eGFR and proteinuria was found. During follow-up (median, 6.4 years), 130 patients reached the renal outcome (107 ESRD and 23 GFR decline of >= 50%). Higher 24 h, daytime and night-time SBP robustly predicted the composite renal endpoint [1.18 (1.10-1.25) for 5mmHg], whereas BPV as measured by the W-SD did not either when expressed as a continuous variable [hazard ratio 0.97 (95% CI 0.91-1.04)] or when categorized into tertiles [1.16 (0.70-1.92) and 0.95 (0.541.68) in II and III tertiles, respectively]. Similar findings were found with CV-24-h SBP. Conclusion: In CKD patients, short-term BPV is strongly associated with 24 h, night-time and daytime BP but is independent from the eGFR and proteinuria and does not predict CKD progression.

引用

页码：2398 / 2405

页数：8

共 34 条

[1] Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease [J].