Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study

Abstract

The “reverse dipping” blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a “dipper”, “non-dipper” and “reverse dippers” was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis.

Clinical and prognostic significance of a reverse dipping pattern on ambulatory monitoring: An updated review

“…The strong relationship between RD and nondipping status with increased urinary protein excretion has been recently confirmed by Wang and colleagues in 588 Chinese patients (67% with chronic glomerulonephritis). Proteinuria in reverse dippers was 66% higher than in dippers and approximately four‐fold greater than in extreme dippers.…”

“…In the setting of CKD, two studies consisting of 1024 individuals evaluated the risk of end‐stage renal disease and nonfatal/fatal cardiovascular events associated with RD. Both reports consistently documented that patients with RD had an increased risk of renal death and cardiovascular events compared with patients with preserved circadian BP rhythm, independently of 24‐hour systolic BP levels …”

Relationship of Non-Dipper and Reverse-Dipper Pattern with Sleep Quality in Normotensive Patients

“…29 Also, the strong relationship between increased urinary protein excretion and the RD and ND pattern is among the recently discussed topics. 30,31 When all these data are evaluated, it is clear that the RD and ND pattern is associated with an increased risk of CV disease. Although interest in sleep disorders has increased in recent years, the diagnosis and treatment of these patients is not yet clear.…”

Hipertansif Hastalarda Reverse-dipper Kan Basıncı ile Nötrofil Lenfosit Oranı Arasındaki İlişki

“…Besides reverse dipping has also been shown to be associated with early carotid plaque formation in hypertensives (12 ). Chang Wang et al showed prognostic value of reverse dipper pattern in chronic kidney disease patients in their studies (13 ). However there was limited data involving cardiovascular effects of reverse dipper pattern.…”