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Clinical Summary

BP variability increases with advancing chronic kidney disease

Takeaway

  • Abnormal dipping patterns are more common in patients with chronic kidney disease (CKD) and deteriorate with advancing stage.
  • All systolic BP (SBP) variability indices measured during 24-hour, day-time and night-time were higher for patients with vs without CKD and increased with advancing stage.

Why this matters

  • BP variability could be treated as a marker for cardiovascular regulatory mechanism and an additional cardiovascular risk factor.

Study design

  • Cross-sectional analysis of 16,546 patients with hypertension, of which 10,270 were without and 6276  with CKD stages 1–5.
  • Funding: Instituto de Salud Carlos III.

Key results

  • Proportion of dippers declined (P<.001) while that of risers increased (P<.001) progressively.
  • Patients with vs without CKD had significantly higher SBP standard deviation (SBPSD; 14.3 vs 13.8 mmHg; P<.001), SBP weighted SD (SBPwSD; 12.6 vs 11.8; P<.001), SBP coefficient of variation (SBPCV; 11.0 vs 10.8; P<.001) and SBP averaged real variability (SBPARV; 10.2 vs 9.7 mmHg; P<.001).
  • An increasing trend was observed for 24-h, day-time and night-time SBPSD, SBPwSD, SBPCV and SBPARV (P<.001 for all).
  • Patients with CKD had lower diastolic BPSD (10.3 vs 10.7 mmHg; P<.001).
  • Male (aOR, 1.185; P=.033), older patients (aOR, 1.038; P<.001), abdominal obesity (aOR, 1.223; P=.006), diabetes (aOR, 1.347; P<.001), number of antihypertensive drugs (aOR, 1.058; P=.021) and clinic SBP (aOR, 1.018; P<.001) were independently associated with increased ARV.

Limitations

  • Cross-sectional study.

References


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