Association of BP Variability with Mortality among African Americans with CKD

Abstract

SummaryBackground and objectives Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.Design, setting, participants, & measurements This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.Results Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.Conclusions In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.

Порівняння Впливу Фіксованої Комбінації Периндоприл/Амлодипін На Ураження Органів-Мішеней У Пацієнтів З Артеріальною Гіпертензією З ішемічною Хворобою Серця Та Без Неї (Результати Дослідження EPHES)

“…В іншому трирічному спостереженні виявлено, що варіабельність АТ є сильним та незалежним від ін-ших факторів ризику предиктором раннього атеро-склерозу сонних артерій у загальній популяції [46]. Серед пацієнтів з хронічним ураженням нирок у 2,82 та 4,9 раза вища загальна та кардіоваскулярна смертність при високій варіабельності САТ [29]. В інших спостереженнях висока варіабельність АТ асоціювалася із зниженням пружно-еластичних властивостей артерій [18,19], наявністю атероскле-ротичних бляшок та збільшенням ниркового судин-ного опору [23].…”

Blood Pressure Variability: Prognostic Value and Therapeutic Implications

“…A prospective observational study of 908 participants with a follow-up period of 3-6.4 years showed a 2.82-and 4.9-fold increase of overall mortality and cardiovascular mortality in patients with chronic kidney disease and high systolic BPV [30]. Different studies have recently established the prognostic role of BPV for the development of arterial pathological changes.…”

The risk of visit-to-visit blood pressure variability in chronic kidney disease

“…Among the outcomes, surrogate endpoints such as changes in renal blood flow or albuminuria, and hard endpoints such as total and cardiovascular mortality were assessed. Overall, risk of total mortality [25], progression to end stage renal disease [28], and cardiovascular disease [25] associated with high VVV was observed. Similarly, high VVV was also associated to progression of albuminuria and worsening of renal function mainly in diabetic patients [15,[29][30][31], although a few studies reported no association [32].…”

“…Previous studies have analysed the association of VVV and events in patients with diverse CKD stages [25,26], as well as in patients with end stage renal disease in renal replacement therapy, peritoneal [27] or haemodialysis [28]. Among the outcomes, surrogate endpoints such as changes in renal blood flow or albuminuria, and hard endpoints such as total and cardiovascular mortality were assessed.…”