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

Katafuchi, Eisuke; Nakayama, Masaru; Tanaka, Shigeru; Sakoh, Teppei; Yoshitomi, Ryota; Fukui, Akiko; Seki, Mitsunori; Nakamata, Yusuke; Tominaga, Mitsuhiro; Tsuruya, Kazuhiko; Kitazono, Takanari

doi:10.1253/circj.cj-17-0063

Cited by 10 publications

(6 citation statements)

References 34 publications

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“…Moreover, mean nocturnal SBP remained independently associated with plasma BNP in the model. This is consistent with previous studies showing the importance of nocturnal BP in predicting the progression of atherosclerosis, target organ damage, and cardiovascular outcome, [16][17][18][19][21][22][23] and may support the clinical utility of nocturnal BP assessment for better managing patients with severe AS.…”

Section: Discussionsupporting

confidence: 92%

“…Several studies have demonstrated that target organ damage and prognosis are more closely associated with nocturnal BP than with diurnal BP or clinical measurement. [17][18][19][20][21][22] Moreover, nocturnal BP monitoring provides data on variability, which has been proven to be associated with subsequent cardiovascular events and cardiovascular mortality. 16,23,24 To date, however, the association between nocturnal BP variables and BNP A ortic stenosis (AS) is common with aging and its prevalence is gradually increasing worldwide.…”

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confidence: 99%

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Greater Nocturnal Blood Pressure Is Associated With Natriuretic Peptide Level in Aortic Stenosis With Preserved Ejection Fraction

Tamura

Iwata

Ito

et al. 2019

Circ J

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Background: Although careful monitoring of asymptomatic severe aortic stenosis (AS) is recommended to prevent missing the optimal timing of surgical or transcatheter aortic valve replacement, prophylactic treatment that could extend the asymptomatic period remains unknown. In a hypertensive population, high blood pressure (BP) measured at the doctor's office is known to be associated with B-type natriuretic peptide (BNP) level, a surrogate marker for symptomatic deterioration in AS. Little is known regarding the association between nocturnal BP variables and BNP in severe AS with preserved ejection fraction (EF). Methods and Results: The subjects consisted of 78 severe AS patients (mean age, 79±6 years) with preserved EF. Nocturnal BP was measured hourly using a home BP monitoring device. On multiple regression analysis, nocturnal mean systolic BP (SBP) remained independently associated with BNP after adjustment for age, sex, body mass index, estimated glomerular filtration rate, antihypertensive medication class, early diastolic mitral annular velocity, and left ventricular mass index (P=0.03), whereas diastolic BP (DBP) and variables of BP variability were not. Conclusions: Higher nocturnal SBP rather than DBP or indices of BP variability was independently associated with BNP in AS patients with preserved EF. Intervention for nocturnal SBP may therefore extend the asymptomatic period and improve prognosis.

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Greater Nocturnal Blood Pressure Is Associated With Natriuretic Peptide Level in Aortic Stenosis With Preserved Ejection Fraction

Tamura

Iwata

Ito

et al. 2019

Circ J

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“…Death occurred before reaching ESRD. Information regarding patient death and definitions of censored patients are described in our previous report [13]. In total, 69 patients were censored; 63 were lost to follow-up and 6 required maintenance hemodialysis because of acute exacerbation of kidney function due to infectious diseases or congestive heart failure.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical assessments at admission and the definitions of hypertension, diabetes mellitus, smoking, and dyslipidemia are described in our previous report [13]. An echocardiogram was performed to assess left atrial diameter and left ventricular ejection fraction.…”

Section: Methodsmentioning

confidence: 99%

Blood urea nitrogen is independently associated with renal outcomes in Japanese patients with stage 3–5 chronic kidney disease: a prospective observational study

et al. 2019

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Background Blood urea nitrogen (BUN) is one of the substances that affects the calculated serum osmolality (cSosm). A previous study demonstrated that BUN and cSosm were independently associated with the development of chronic kidney disease (CKD) in patients with preserved kidney function. In advanced CKD stages, there is a concomitant increase in cSosm and BUN levels. However, it remains unclear whether BUN or cSosm levels are related to renal outcomes in patients with moderate to severe kidney dysfunction. The aim of this study was to clarify whether the BUN or cSosm level is associated with kidney disease progression in patients with advanced CKD. Methods In this prospective study, we enrolled 459 patients with CKD (stages 3–5). The composite renal endpoint was end-stage renal disease (ESRD) or death, and ESRD alone was added as an alternative outcome. A Cox proportional hazards model was utilized to determine the risk factors for a poor renal outcome. We adjusted for covariates including estimated glomerular filtration rate (eGFR). The cSosm (mOsm/kg) was calculated using the following formula: (2 × sodium) + (BUN/2.8) + (glucose/18). Results During a median follow-up of 25.8 months, the renal endpoint was observed in 210 patients. Multivariable Cox analysis determined the hazard ratio (HR) [95% confidence interval (CI)] for the composite renal outcome in the second, third, and fourth BUN quartiles were 1.36 (0.72–2.58), 1.87 (0.95–3.66), and 2.66 (1.23–5.76) ( P for trend < 0.01), respectively compared with the first BUN quartile. Conversely, by multivariable Cox analysis, the HRs (95% CIs) for poor outcomes in the second, third, and fourth cSosm quartiles, compared with the first cSosm quartile, were 1.13 (0.69–1.87), 0.95 (0.58–1.55), and 1.26 (0.78–2.03), respectively ( P for trend = 0.39). In addition, with regard to the renal outcome of ESRD alone, higher BUN quartiles had a significantly increased risk for the outcome, but cSosm levels were not associated with the outcome. Conclusions Higher BUN levels, but not cSosm levels, were associated with adverse renal outcomes independent of the eGFR, suggesting that BUN may be a useful marker for predicting kidney disease progression. Electronic supplementary material The online version of this article (10.1186/s12882-019-1306-1) contains supplementary material, which is available to authorized users.

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“…Controversy remains regarding the appropriate time of BP measurement in relation to renal outcomes or death. In the present study, daytime BP was of greater importance in predicting ESRD, whereas nighttime BP was of greater importance [19,20]. In a study on 682 hypertensive patients who underwent echocardiography, nocturnal BP, rather than non-dipping, showed better prediction of left ventricular hypertrophy (LVH), especially in patients with a high cardiovascular risk [21].…”

Section: Discussionmentioning

confidence: 48%

Association of ambulatory blood pressure monitoring with renal outcome in patients with chronic kidney disease

Son

Ryu

et al. 2020

Kidney Res Clin Pract

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Background: The significance of ambulatory blood pressure (ABP) in Korean patients with chronic kidney disease (CKD) in relation to renal outcome or death remains unclear. We investigated the role of ABP in predicting end-stage renal disease or death in patients with CKD. Methods: We enrolled 387 patients with hypertension and CKD who underwent ABP monitoring and were followed for 1 year. Data on clinical parameters and outcomes from August 2014 to May 2018 were retrospectively collected. The composite endpoint was end-stage renal disease or death. Patients were grouped according to the mean ABP. Results: There were 66 endpoint events, 52 end-stage renal disease cases, and 15 mortalities. Among all patients, one developed end-stage renal disease and died. Mean ABP in the systolic and diastolic phases were risk factors for the development of composite outcome with hazard ratios of 1.03 (95% confidence interval [CI], 1.01-1.04; P < 0.001) and 1.04 (95% CI, 1.02-1.07; P = 0.001) for every 1 mmHg increase in BP, respectively. Patients with mean ABP between 125/75 and 130/80 mmHg had a 2.56-fold higher risk for the development of composite outcome (95% CI, 0.72-9.12; P = 0.147) as compared to those with mean ABP ≤ 125/75 mmHg. Patients with mean ABP ≥ 130/80 mmHg had a 4.79-fold higher risk (95% CI, 1.68-13.70; P = 0.003) compared to those with mean ABP ≤ 125/75 mmHg. Office blood pressure (OBP) was not a risk factor for the composite outcome when adjusted for covariates. Conclusion: In contrast to OBP, ABP was a significant risk factor for end-stage renal disease or death in CKD patients.

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

Cited by 10 publications

References 34 publications

Greater Nocturnal Blood Pressure Is Associated With Natriuretic Peptide Level in Aortic Stenosis With Preserved Ejection Fraction

Greater Nocturnal Blood Pressure Is Associated With Natriuretic Peptide Level in Aortic Stenosis With Preserved Ejection Fraction

Blood urea nitrogen is independently associated with renal outcomes in Japanese patients with stage 3–5 chronic kidney disease: a prospective observational study

Association of ambulatory blood pressure monitoring with renal outcome in patients with chronic kidney disease

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