Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World

Drawz, Paul; Brown, Roland; Nicola, Luca De; Fujii, Naohiko; Gabbai, Francis B.; Gassman, Jennifer; He, Jiang; Iimuro, Satoshi; Lash, James P.; Minutolo, Roberto; Phillips, Robert A.; Rudser, Kyle; Ruilope, Luís M.; Steigerwalt, Susan; Townsend, Raymond R.; Xie, Dawei; Rahman, Mahboob

doi:10.2215/cjn.13181117

Cited by 35 publications

(26 citation statements)

References 41 publications

(46 reference statements)

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“…More recently, a study from the International Database of Ambulatory BP in Renal Patients collaborative group showed wide variations in 24-hour BP profiles in patients with nondialysis CKD from 7 studies in 4 countries. 33 Like ours, that study showed poor BP control in European cohorts, either according to clinic BP or to combined clinic and ambulatory BP. Its finding that European participants had the highest likelihood of white-coat hypertension suggests that clinic BP may be particularly overestimated in this population.…”

Section: Discussionsupporting

confidence: 55%

Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Pinho¹,

Levin²,

Fukagawa³

et al. 2019

Kidney International

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A rterial hypertension is prevalent in chronic kidney disease (CKD) and contributes to its adverse outcomes. 1 The major benefits of lowering blood pressure (BP) for survival and cardiovascular outcomes are well established, as are those of inhibiting the renin angiotensinaldosterone system (RAAS) to slow CKD progression. 2-8 BP control and RAAS inhibitor use are therefore major goals in the management of patients with CKD, 9 although no consensus exists about the ideal BP level. Current guidelines

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Section: Discussionsupporting

confidence: 55%

Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Pinho¹,

Levin²,

Fukagawa³

et al. 2019

Kidney International

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“…Similarly, the prevalence of white coat hypertension contributing to ATRH was 39% in a Spanish study (24). This is consistent with previously reported differences in white coat hypertension across different countries and racial-ethnic groups in patients with CKD (25). The reasons underlying these differences remain unclear and require further study.…”

Section: Discussionsupporting

confidence: 92%

Apparent Treatment-Resistant Hypertension Assessed by Office and Ambulatory Blood Pressure in Chronic Kidney Disease—A Report from the Chronic Renal Insufficiency Cohort Study

et al. 2020

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BackgroundApparent treatment-resistant hypertension is common in patients with CKD. Whether measurement of 24-hour ambulatory BP monitoring is valuable for risk-stratifying patients with resistant hypertension and CKD is unclear.MethodsWe analyzed data from the Chronic Renal Insufficiency Cohort study, a prospective study of participants (n=1186) with CKD. Office BP was measured using standardized protocols; ambulatory BP was measured using Spacelabs monitors. Apparent treatment-resistant hypertension was defined on the basis of office BP, ambulatory BP monitoring, and use of more than three antihypertensive medications. Outcomes were composite cardiovascular disease, kidney outcomes, and mortality. Groups were compared using Cox regression analyses with a control group of participants without apparent treatment-resistant hypertension.ResultsOf 475 participants with apparent treatment-resistant hypertension on the basis of office BP, 91.6% had apparent treatment-resistant hypertension confirmed by ambulatory BP monitoring. Unadjusted event rates of composite cardiovascular disease, kidney outcomes, and mortality were higher in participants with ambulatory BP monitoring–defined apparent treatment-resistant hypertension compared with participants without apparent treatment-resistant hypertension. In adjusted analyses, the risks of composite cardiovascular disease (hazard ratio, 1.27; 95% confidence interval [95% CI], 0.59 to 2.7), kidney outcomes (hazard ratio, 1.68; 95% CI, 0.88 to 3.21), and mortality (hazard ratio, 1.27; 95% CI, 0.5 to 3.25) were not statistically significantly higher in participants with ambulatory BP monitoring–defined apparent treatment-resistant hypertension compared with participants without apparent treatment-resistant hypertension.ConclusionsIn our study population with CKD, most patients with apparent treatment-resistant hypertension defined on the basis of office BP have apparent treatment-resistant hypertension confirmed by ambulatory BP monitoring. Although ABPM-defined apparent treatment-resistant hypertension was not independently associated with clinical outcomes, it identified participants at high risk for adverse clinical outcomes.

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“…Previous studies have compared the prevalence of comorbidities and incidence of CKD complications across populations with CKD from different countries. 1,5,33,34 A study of 5 international CKD cohorts reported a variable prevalence of masked and sustained hypertension assessed by 24-hour blood pressure monitoring despite adjustments for comorbidities and levels of eGFR. 33 Another study explored differences in the incidence of ESRD between white individuals in the United States and those from Norway, standardized for age and sex.…”

Section: Contrast With Other International Comparisonsmentioning

confidence: 99%

A collaborative, individual-level analysis compared longitudinal outcomes across the International Network of Chronic Kidney Disease (iNETCKD) cohorts

Orlandi

Huang

Fukagawa

et al. 2019

Kidney International

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Rates of chronic kidney disease (CKD) progression, end stage kidney disease (ESKD), all-cause mortality, and cardiovascular (CVD) events among individuals with CKD vary widely across countries. Well-characterized demographic, comorbidity, and laboratory markers captured for prospective cohorts may explain, in part, such differences. To investigate whether core characteristics of individuals with CKD explain differences in rates of outcomes, we conducted an individual-level analysis of eight studies that are part of iNET-CKD, an international network of CKD cohort studies. Overall, the rate of CKD progression was 40 events/1000 person-year (95% confidence interval 39-41), 28 (27-29) for ESKD, 41 (40-42) for death, and 29 (28-30) for CVD events. However, standardized rates were highly heterogeneous across studies (over 92.5%). Interactions by study group on the association between baseline characteristics and outcomes were then identified. For example, the adjusted hazard ratio for CKD progression was 0.44 (95% confidence interval 0.35-0.56) for women vs. men among the Japanese (CKD-JAC), while it was 0.66 (0.59-0.75) among the Uruguayan (NRHP). The adjusted hazard ratio for ESKD was 2.02 (95% CI 1.88-2.17) per 10 units lower baseline eGFR among Americans (CRIC), while it was 3.01 (2.57-3.53) among Canadians (CanPREDDICT) (significant interaction for comparisons across all studies). The risks of CKD progression, ESKD, death, and CVD vary across countries even after accounting for the distributions of age, sex, comorbidities, and laboratory markers. Thus, our findings support the need for a better understanding of specific factors in different populations that explain this variation.

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Variations in 24-Hour BP Profiles in Cohorts of Patients with Kidney Disease around the World

Abstract: In a large, multinational database, the prevalence of masked and sustained hypertension varied across cohorts independent of important comorbidities.

Cited by 35 publications

References 41 publications

Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Considerable international variation exists in blood pressure control and antihypertensive prescription patterns in chronic kidney disease

Apparent Treatment-Resistant Hypertension Assessed by Office and Ambulatory Blood Pressure in Chronic Kidney Disease—A Report from the Chronic Renal Insufficiency Cohort Study

A collaborative, individual-level analysis compared longitudinal outcomes across the International Network of Chronic Kidney Disease (iNETCKD) cohorts

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