Comparison of Ambulatory Blood Pressure Parameters of Hypertensive Patients With and Without Chronic Kidney Disease

Abstract

There is strong association between chronic kidney disease (CKD) and increased prevalence of hypertension, risk of end-organ damage, and cardiovascular disease (CVD). Non-dipping, as determined by ambulatory blood pressure (BP) monitoring (ABPM), is frequent in CKD and has also been consistently associated with increased CVD risk. The reported prevalence of non-dipping in CKD is highly variable, probably due to relatively small sample sizes, reliance only on a single, low-reproducibility, 24-h ABPM evaluation per participant, and definition of daytime and nighttime periods by arbitrary fixed clock-hour spans. Accordingly, we assessed the circadian BP pattern of patients with and without CKD by 48-h ABPM to increase reproducibility of the results. This cross-sectional study involved 10 271 hypertensive patients (5506 men/4765 women), 58.0 ± 14.2 (mean ± SD) yrs of age, enrolled in the Hygia Project. Among the participants, 3227 (1925 men/1302 women) had CKD. At the time of recruitment, 568/2234 patients with/without CKD were untreated for hypertension. Patients with than without CKD were more likely to be men and of older age, have diagnoses of obstructive sleep apnea, metabolic syndrome, diabetes, and/or obesity, plus have higher glucose, creatinine, uric acid, and triglyceride, but lower cholesterol, concentrations. In patients with CKD, ambulatory systolic BP (SBP) was significantly elevated (p < .001), mainly during the hours of nighttime sleep, independent of presence/absence of BP-lowering treatment. In patients without CKD, ambulatory diastolic BP (DBP), however, was significantly higher (p < .001), mainly during the daytime. Differing trends for SBP and DBP between groups resulted in large differences in ambulatory pulse pressure (PP), it being significantly greater (p < .001) for the entire 24 h in patients with CKD. Prevalence of non-dipping was significantly higher in patients with than without CKD (60.6% vs. 43.2%; p < .001). The largest difference between groups was in the prevalence of the riser BP pattern, i.e., asleep SBP mean > awake SBP mean (17.6% vs. 7.1% in patients with and without CKD, respectively; p < .001). The riser BP pattern significantly and progressively increased from 8.1% among those with stage 1 CKD to a very high 34.9% of those with stage 5 CKD. Elevated asleep SBP mean was the major basis for the diagnosis of hypertension and/or inadequate BP control among patients with CKD; thus, among the uncontrolled hypertensive patients with CKD, 90.7% had nocturnal hypertension. Our findings document significantly elevated prevalence of a blunted nocturnal BP decline in hypertensive patients with CKD. Most important, prevalence of the riser BP pattern, associated with highest CVD risk among all possible BP patterns, was 2.5-fold more prevalent in CKD, and up to 5-fold more prevalent in end-stage renal disease. Patients with CKD also presented significantly elevated ambulatory PP, reflecting increased arterial stiffness and enhanced CVD risk. Collectively, these findings indicate that CKD s...

Comparison of Prognostic Values of Daytime and Night-Time Systolic Blood Pressures on Renal Outcomes in Patients With Chronic Kidney Disease

“…In previous reports, the prevalence of non-dipping in CKD patients varied markedly, ranging from 47% to 80%. 13-15,17,26, 27 The current study showed a high prevalence (80%) of nondipping, similar to previous studies. 13,15,26 This wide range in the prevalence of non-dipping might be attributable to differences in the studied populations, sample sizes, time of setting of ABPM, proportions of patients treated with antihypertensive agents, or the degree of kidney dysfunction in each cohort.…”

The Complex Relationship Between CKD and Ambulatory Blood Pressure Patterns

“…16 More recently a large cross sectional study reported on the prevalence of nondipping in hypertensive CKD. 31 This study included 10,271 patients referred for ABPM in northwest Spain who were enrolled in the Hygia Project, a study of ABPM and BP treatment to reduce cardiovascular events. All patients were hypertensive by 48 hour ABPM criteria, and 3,227 patients had CKD defined as estimated glomerular filtration rate (GFR) < 60 mL/min/1.73m 2 or microalbuminuria on 2 occasions at least 3 months apart.…”

Ocena zależności pomiędzy dobowym profilem ciśnienia tętniczego a natriurezą u pacjentów z przewlekłą chorobą nerek oraz po przeszczepieniu nerki.

“…In a landmark study, the Modification of Diet in Renal Disease (MDRD) trial, intensive blood pressure control -BP target of 125/75 mm Hg -resulted in a significant prolongation of time to renal replacement therapy by more than 1 year in patients with moderate renal impairment (mean GFR 38.6 mL/min) [11]. In addition to the high prevalence of hypertension in the population of patients with chronic kidney disease [8], which is 80% in patients with end-stage kidney disease, additional problem is treatment resistance [12] and disturbed circadian BP pattern -frequent occurrence of non-dipping and reverse-dipping in this group of patients [13][14][15] which was also observed in our study. All patients with chronic kidney disease observed in our study were diagnosed with hypertension and more than 80% had abnormal circadian blood pressure profile.…”