Visit-to-visit variability in blood pressure and the development of chronic kidney disease in treated general hypertensive patients
- 18 May 2019
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 35 (10), 1739-1746
- https://doi.org/10.1093/ndt/gfz093
Abstract
Background Data on the association between visit-to-visit variability (VVV) in blood pressure (BP) and the risk of chronic kidney disease (CKD) in general treated hypertensive patients were limited. We aimed to evaluate the relation of VVV in BP with the development of CKD, and examine any possible effect modifiers in hypertensive patients without prior cardiovascular diseases (CVDs) or CKD. Methods This is a post hoc analysis of the Renal Sub-study of the China Stroke Primary Prevention Trial (CSPPT). A total of 10 051 hypertensives without CVD and CKD and with at least six visits of BP measurements from randomization to the 24-month visit were included. The main VVV in BP was expressed as standard deviation (SD). The primary outcome was the development of CKD, defined as a decrease in estimated glomerular filtration rate ≥30% and to a level of <60 mL/min/1.73 m2, or end-stage renal disease. Results The median treatment duration was 4.4 years. After multivariable adjustment, including baseline systolic blood pressure (SBP) and mean SBP during the first 2-year treatment period, there was a significantly positive relationship of SD of SBP with the risk of CKD development (per SD increment; odds ratio, 1.27; 95% confidence interval: 1.10–1.46). The results were similar for coefficient of variation (CV) of SBP. Results across various subgroups, including age, sex, SBP at baseline, treatment compliance, concomitant antihypertensive medications and mean SBP during the first 24-month treatment period, were consistent. Conclusions SBP variability, irrespective of mean BP level, was significantly associated with the development of CKD in general treated hypertensive patients.Funding Information
- National key research and development program (2016YFE0205400, 2016YFC0903103, 2016YFC0904900, 2018ZX09739, 2018ZX09301034003)
This publication has 25 references indexed in Scilit:
- The risk of diabetic renal function impairment in the first decade after diagnosed of diabetes mellitus is correlated with high variability of visit-to-visit systolic and diastolic blood pressure: a case control studyBMC Nephrology, 2017
- Visit-to-visit blood pressure variability is a risk factor for all-cause mortality and cardiovascular diseaseJournal of Hypertension, 2017
- Visit-to-Visit Variability of Blood Pressure and Cardiovascular Disease and All-Cause MortalityHypertension, 2014
- Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of End-Stage Renal Disease and MortalityJAMA, 2014
- US Renal Data System 2013 Annual Data ReportAmerican Journal of Kidney Diseases, 2014
- Effects of Visit-to-Visit Variability in Systolic Blood Pressure on Macrovascular and Microvascular Complications in Patients With Type 2 Diabetes MellitusCirculation, 2013
- Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice GuidelineAnnals of Internal Medicine, 2013
- Within-Subject Blood Pressure Level—Not Variability—Predicts Fatal and Nonfatal Outcomes in a General PopulationHypertension, 2012
- Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney diseaseHypertension Research, 2012
- Prevalence of chronic kidney disease in China: a cross-sectional surveyThe Lancet, 2012