RT Journal Article
SR Electronic
T1 Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in Chronic Kidney Disease Patients
JF Clinical Journal of the American Society of Nephrology
JO CLIN J AM SOC NEPHROL
FD American Society of Nephrology
SP CJN.04030318
DO 10.2215/CJN.04030318
A1 Mallamaci, Francesca
A1 Tripepi, Giovanni
A1 D’Arrigo, Graziella
A1 Borrelli, Silvio
A1 Garofalo, Carlo
A1 Stanzione, Giovanna
A1 Provenzano, Michele
A1 De Nicola, Luca
A1 Conte, Giuseppe
A1 Minutolo, Roberto
A1 Zoccali, Carmine
YR 2019
UL http://cjasn.asnjournals.org/content/early/2019/01/01/CJN.04030318.abstract
AB Background and objectives Short-term BP variability (derived from 24-hour ambulatory BP monitoring) and long-term BP variability (from clinic visit to clinic visit) are directly related to risk for cardiovascular events, but these relationships have been scarcely investigated in patients with CKD, and their prognostic value in this population is unknown.Design, setting, participants, & measurements In a cohort of 402 patients with CKD, we assessed associations of short- and long-term systolic BP variability with a composite end point of death or cardiovascular event. Variability was defined as the standard deviation of observed BP measurements. We further tested the prognostic value of these parameters for risk discrimination and reclassification.Results Mean ± SD short-term systolic BP variability was 12.6±3.3 mm Hg, and mean ± SD long-term systolic BP variability was 12.7±5.1 mm Hg. For short-term BP variability, 125 participants experienced the composite end point over a median follow-up of 4.8 years (interquartile range, 2.3–8.6 years). For long-term BP variability, 110 participants experienced the composite end point over a median follow-up of 3.2 years (interquartile range, 1.0–7.5 years). In adjusted analyses, long-term BP variability was significantly associated with the composite end point (hazard ratio, 1.24; 95% confidence interval, 1.01 to 1.51 per 5-mm Hg higher SD of office systolic BP), but short-term systolic BP variability was not (hazard ratio, 0.92; 95% confidence interval, 0.68 to 1.25 per 5-mm Hg higher SD of 24-hour ambulatory systolic BP). Neither estimate of BP variability improved risk discrimination or reclassification compared with a simple risk prediction model.Conclusions In patients with CKD, long-term but not short-term systolic BP variability is related to the risk of death and cardiovascular events. However, BP variability has a limited role for prediction in CKD.