Visit‐to‐Visit Variability of Blood Pressure and Renal Function Decline in Patients With Diabetic Chronic Kidney Disease

Yokota, Kazuhisa; Fukuda, Masakazu; Matsui, Yoshio; Kario, Kazuomi; Kimura, Kenjiro

doi:10.1111/jch.12293

Cited by 19 publications

(19 citation statements)

References 39 publications

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“…Additional predictors of higher systolic BPV over the ≥ 4-year follow-up period included higher baseline SBP and age and being male or a smoker. These predictors are all well-known risk factors for CVD and in line with other studies of renal decline and BPV [11, 24, 26, 37]. In a post hoc analysis of ALLHAT data alone, higher BPV was associated with a higher risk of renal outcomes, independently from mean BP [33].…”

Section: Discussionsupporting

confidence: 63%

“…In diabetic individuals with nephropathy, visit-to-visit systolic BPV was associated independently with kidney disease outcomes, such as increased overall mortality and cardiovascular mortality [25]. However, in a study of diabetic patients with Stage 3-4 CKD, no association between BPV and renal decline was seen [26]. Furthermore, in a population of elderly CKD patients without CVD, an association between BPV and risk for mortality was found, but no link between BPV and CKD progression to dialysis was seen [27].…”

Section: Introductionmentioning

confidence: 99%

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Relationship Between Visit-to-Visit Blood Pressure Variability (BPV) and Kidney Function in Patients with Hypertension

Jeffers

Zhou²

2017

Kidney Blood Press Res

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Background/Aims: To investigate the impact of kidney function (using estimated glomerular filtration rate, [eGFR]) on blood pressure variability (BPV) via a retrospective post hoc analysis of patients with hypertension enrolled in two large clinical trials. Methods: Subject-level data were extracted from ASCOT (N=18,852) and ALLHAT (N=26,441) databases; both were randomized, active controlled studies, with treatment duration for hypertension ≥4 years. Visit-to-visit BPV was assessed using the square root of the coefficient of variation of systolic blood pressure (SBP) across visits from 12 weeks onwards. Baseline GFR, estimated by the simplified Modification of Diet in Renal Disease equation, was stratified into ≤60, 61-90, and >90 mL/min/1.73 m². The relationship between baseline eGFR and systolic BPV was analyzed using an analysis of covariance, with baseline factors considered as covariates. Studies were pooled and analyzed individually. Results: Patient characteristics were largely consistent between studies. In the pooled population (n=38,133) there were 19.1%, 62.9%, and 18.0% patients, with eGFR ≤60, 61-90, and > 90 mL/min/1.73 m², respectively. Patients with lower baseline eGFR had higher systolic BPV, in the pooled population and the individual analyses. Other baseline predictors of high systolic BPV included high SBP and age, being male, and a smoker. An amlodipine-based regimen was a negative predictor of high systolic BPV, vs. other antihypertensives, regardless of eGFR. Conclusions: Patients with declining renal function tended to have higher systolic BPV vs. those without, even after adjusting for risk factors. Amlodipine-based therapy reduced BPV more than other antihypertensive agents, regardless of level of eGFR.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Relationship Between Visit-to-Visit Blood Pressure Variability (BPV) and Kidney Function in Patients with Hypertension

Jeffers

Zhou²

2017

Kidney Blood Press Res

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“…In this study, RAS inhibitor dosage was adjusted according to the patient's condition, perhaps causing the differences between studies. Evidence indicates that visit-to-visit systolic BP variability was associated with poor renal prognosis [28,29]; so, we considered visit-to-visit systolic BP variability could also be associated with eGFR variability, but found no strong associations between systolic BP-CV and residual eGFR-CV. With only 8 cardiovascular events, and 3 deaths, we were unable to speculate on the effect of eGFR variability on cardiovascular events or death in this study.…”

Section: Discussionmentioning

confidence: 94%

Estimated Glomerular Filtration Rate Variability Independently Predicts Renal Prognosis in Advanced Chronic Kidney Disease Patients

Uehara

Yasuda

Shibagaki

et al. 2015

Nephron

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Background: We often experience visit-to-visit estimated glomerular filtration rate (eGFR) variability among patients with advanced chronic kidney disease (CKD). However, the impact of eGFR variability on renal prognosis is not well understood. Methods: The Kanagawa Valsartan Trial was a multicenter, randomized, open-label trial that compared the effect of add-on treatment with angiotensin II receptor blocker, valsartan, with that of conventional treatment on the rate of CKD progression in 293 advanced CKD patients. In this post hoc analysis, we compared the effect of high eGFR variability on end-stage renal disease (ESRD). To evaluate eGFR variability, we chose participants with ≥5 serial measurements of eGFR during the study period and assessed the residual coefficient of variation (CV) of eGFR (residual eGFR-CV) derived from a regression line of eGFR (eGFR slope). The primary end point was the first event of ESRD. Results: Among 237 patients with ≥5 serial measurements of eGFR in a median follow-up of 1.47 years, there were 54 ESRD events in the higher than median residual eGFR-CV group and 36 ESRD events in the lower than median eGFR-CV group (log-rank test, p = 0.008). In multivariate Cox regression analysis, high eGFR variability was significantly associated with the primary end point as well as hypertension, high proteinuria, low baseline eGFR and steep eGFR slope (hazards ratio 2.11, 95% CI 1.33-3.33, p = 0.001). Conclusion: High eGFR variability predicts poor renal prognosis; therefore, further attention is warranted for ambulatory patients with large eGFR fluctuations, especially those with advanced CKD.

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“…Specifically, the visit-to-visit variability of systolic BP (SBP) had been shown to be a novel biomarker for the development of stroke and coronary artery diseases [14–19], the progression of a carotid artery stenosis and peripheral vascular disease [20–22], and the deterioration in renal function for stages 3-4 diabetic chronic kidney disease (CKD) patients [23]. However, little is known about the long-term association of BP visit-to-visit variability with PAD occurrence in diabetic patients with normal ABI at diagnosis.…”

Section: Introductionmentioning

confidence: 99%

High Systolic and Diastolic Blood Pressure Variability Is Correlated with the Occurrence of Peripheral Arterial Disease in the First Decade following a Diagnosis of Type 2 Diabetes Mellitus: A New Biomarker from Old Measurement

Yeh

Huang

et al. 2016

BioMed Research International

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Background. To assess whether the visit-to-visit variability in blood pressure (BP) is a risk factor of peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM) 10 years after diagnosis. Methods. The electronic medical records of 825 patients, who were diagnosed with type 2 diabetes mellitus (T2DM) during 2000–2002 and regularly followed for 10 years, were retrospectively reviewed. A total of 53,284 clinic visit records, including analysis of BP, BMI, serum glycohemoglobin, and lipid profile, were analyzed. Results. Patients were categorized into two groups according to their visit-to-visit variability in systolic and diastolic BP (SBP and DBP, resp.). The high-risk group included patients with high SBP and DBP visit-to-visit variability; this group had a 1.679-fold (95% CI: 1.141–2.472, P = 0.009) increased risk of PAD compared with patients in the low-risk group. Cox regression analysis also demonstrated that the age at which the patients were diagnosed with T2DM, smoking status, and mean creatinine level was significantly associated with increased risk of PAD with a hazard ration of 1.064 (95% CI: 1.043–1.084, P < 0.001), 1.803 (95% CI: 1.160–2.804, P = 0.009), and 1.208 (95% CI: 1.042–1.401, P = 0.012), respectively. Conclusions. High SBP and DBP visit-to-visit variability is correlated with PAD in the first decade following a diagnosis of T2DM.

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Visit‐to‐Visit Variability of Blood Pressure and Renal Function Decline in Patients With Diabetic Chronic Kidney Disease

Cited by 19 publications

References 39 publications

Relationship Between Visit-to-Visit Blood Pressure Variability (BPV) and Kidney Function in Patients with Hypertension

Relationship Between Visit-to-Visit Blood Pressure Variability (BPV) and Kidney Function in Patients with Hypertension

Estimated Glomerular Filtration Rate Variability Independently Predicts Renal Prognosis in Advanced Chronic Kidney Disease Patients

High Systolic and Diastolic Blood Pressure Variability Is Correlated with the Occurrence of Peripheral Arterial Disease in the First Decade following a Diagnosis of Type 2 Diabetes Mellitus: A New Biomarker from Old Measurement

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