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American Journal of Kidney Diseases

Short-term Blood Pressure Variability and Incident CKD in Patients With Hypertension: Findings From the Cardiovascular and Metabolic Disease Etiology Research Center–High Risk (CMERC-HI) Study

Published:October 11, 2022DOI:https://doi.org/10.1053/j.ajkd.2022.08.017

      ABSTRACT

      Rationale & Objective

      The association between short-term blood pressure variability (BPV) and kidney outcomes is poorly understood. This study evaluated the association between short-term BPV and incident chronic kidney disease (CKD) in people with hypertensive.

      Study Design

      Prospective observational cohort study.

      Setting & Participants

      1,173 hypertensive participants in the Cardiovascular and Metabolic Disease Etiology Research Center–High Risk (2013–2018) Study with estimated glomerular filtration rates (eGFR) ≥60 mL/min/1.73 m2.

      Exposure

      Short-term BPV assessed by average real variability (ARV).

      Outcome

      Kidney disease composite outcome (30% decline in eGFR from baseline, new occurrence of eGFR <60 mL/min/1.73 m2, or onset of UPCR >300 mg/g).

      Analytic Approach

      Multivariable Cox regression analyses to evaluate the association between systolic and diastolic BP-ARV (SBP-ARV and DBP-ARV) and outcomes.

      Results

      During a median follow-up of 5.4 [4.1-6.5] years, 271 events (46.5 per 1,000 person-years) of the kidney disease composite outcome occurred. Multivariable Cox analysis revealed that the highest SBP- and DBP-ARV tertiles were associated with a higher risk of the composite kidney disease outcome than the lowest tertiles, independent of the 24-hour SBP or DBP levels (hazard ratios [HR], 1.64; 95% confidence interval [CI], 1.16-2.33 and HR 1.60; 95% CI, 1.15-2.24 for SBP-ARV and DBP-ARV, respectively. These associations were consistent when SBP- and DBP-ARVs were treated as continuous variables (HR per 1.0 increase in SBP-ARV, 1.03; 95% CI, 1.01-1.06 and HR per 1.0 increase in DBP-ARV, 1.04; 95% CI, 1.01-1.08). These associations were consistent, irrespective of subgroups (age, sex, 24-hour SBP or DBP, and microalbuminuria). However, other measures of short-term BPV including standard deviation, coefficient of variation, and dipping patterns were not associated with incident CKD.

      Limitations

      Observational study design, the use of single period measurement of 24-hour BP only, lack of the changes in antihypertensive medication during the follow-up.

      Conclusions

      Short-term BPV is associated with the development of a kidney disease composite outcome in hypertensive patients.

      Graphical abstract

      Keywords

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