Short‐Term Systolic Blood Pressure Variability and Kidney Disease Progression in Patients With Chronic Kidney Disease: Results From C‐STRIDE

Abstract

Background It is unclear whether short‐term blood pressure variability is associated with renal outcomes in patients with chronic kidney disease. Methods and Results This study analyzed data from participants in the C‐ STRIDE (Chinese Cohort Study of Chronic Kidney Disease) who had chronic kidney disease stages 1 to 4. Short‐term blood pressure variability was measured by calculating the weighted SD (w‐ SD ) of systolic blood pressure ( SBP ). Renal outcomes were defined as dialysis initiation and/or transplantation. Risk factors associated with w‐ SD of SBP were evaluated by linear regression. Associations of short‐term SBP variability with renal outcomes were evaluated by Cox regression. In total, 1421 patients with chronic kidney disease were included in this study (mean age, 49.4±13.6 years; 56.2% men; estimated glomerular filtration rate, 50.5±29.3 mL/min per 1.73 m 2 ; proteinuria, 0.9 [0.3–2.0] g/d). Mean w‐ SD of SBP was 12.6±4.4 mm Hg. w‐ SD of SBP was independently associated with older age, 24‐hour SBP , blood pressure circadian pattern, and angiotensin II receptor blocker treatment. During a median follow‐up of 4.9 years, 237 patients developed renal outcomes (37.01 per 1000 patient‐years). The incidence rate increased across the quartiles of w‐ SD (log‐rank P =0.005). w‐ SD of SBP was associated with an increased risk of renal outcomes, both as a continuous variable (hazard ratio [HR], 1.47; 95% CI, 1.09–1.99) and as a categorical variable (quartile 4 versus quartile 1: HR, 1.60; 95% CI, 1.08–2.36), independent of 24‐hour SBP , daytime SBP , and nighttime SBP . Conclusions Short‐term SBP was independently associated with the risk of dialysis initiation and/or transplantation in patients with chronic kidney disease .

24‐h ambulatory blood pressure variability and hypertensive nephropathy in Han Chinese hypertensive patients

“…20 Wang and colleagues reported that wSD was associated with the risk of dialysis initiation and/or transplantation in patients with CKD. 21 However, in the telehealth-based Vascular health Assessment of the hypertensive (VASOTENS) Registry, 24-h SBP ARV was not associated with neither decreased eGFR nor increased urine albumin excretion in hypertensive patients. 22 Due to conflicting data, more evidence is still needed to comprehensively investigate the impact of mean BP and various BPV parameters on renal function decline in hypertensive patients.…”

“…20 Wang and colleagues reported that wSD was associated with the risk of dialysis initiation and/or transplantation in patients with CKD. 21 To the best of our knowledge, the current study first conducted a prospective evaluation of the relationship between five different short-term BPV parameters derived from ABPM and hypertensive nephropathy in Han Chinese hypertensive patients. The current study showed that 24-h mean BP was more important than shortterm BPV in the prevention of hypertensive nephropathy.…”

Longitudinal Follow-Up and Outcomes for Chinese Patients with Stage 1–4 Chronic Kidney Disease

“…C-STRIDE is an ongoing cohort study initiated in November 2011, which includes patients with stage 1–4 CKD and various etiologies in 39 tertiary academic hospitals around China. The detailed study design and methods have been published previously [10, 11]. There are 2 criteria to be eligible for enrollment.…”

The Pivotal Role of Oxidative Stress in the Pathophysiology of Cardiovascular-Renal Remodeling in Kidney Disease

“…Tubular injury do to hypertension is associated to damage of peritubular capillaries which triggers hypoxia, microvasculature dysfunction, inflammation and finally turns into intersitial fibrosis [37]. Together with chronic uncontrolled hypertension, BP variability is also associated to a high risk of renal outcomes [38,39]. Observations from our cohort of CKD patients linked BP variability with a prevalence of sleep disorders such as obstructive sleep apnea, insomnia and restless leg syndrome further supporting the hypothesis that endothelial dysfunction and glomerular damage play a crucial role in the development of BP variation and in worsen disease progression in these patients [40][41][42].…”