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Observational Study
. 2016 Mar 7;11(3):471-80.
doi: 10.2215/CJN.04660415. Epub 2016 Feb 18.

Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT

Jeff Whittle  1 , Amy I Lynch  2 , Rikki M Tanner  2 , Lara M Simpson  3 , Barry R Davis  3 , Mahboob Rahman  4 , Paul K Whelton  5 , Suzanne Oparil  6 , Paul Muntner  7
Affiliations
Observational Study

Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT

Jeff Whittle et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Design, setting, participants, & measurements: We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril. The composite outcome included incident ESRD after assessment of SD of systolic BP or ≥50% decline in eGFR between 24 months and 48 or 72 months after randomization. We repeated the analyses using average real variability and peak value of systolic BP and for visit-to-visit variability of diastolic BP.

Results: Over a mean follow-up of 3.5 years, 297 outcomes occurred. After multivariable adjustment, including baseline eGFR and mean systolic BP, the hazard ratios for the composite end point were 1.29 (95% confidence interval [95% CI], 0.75 to 2.22), 1.76 (95% CI, 1.06 to 2.91), 1.46 (95% CI, 0.88 to 2.45), and 2.05 (95% CI, 1.25 to 3.36) for the second through fifth (SD of systolic BP =6.63-8.82, 8.83-11.14, 11.15-14.56, and >14.56 mmHg, respectively) versus the first (SD of systolic BP <6.63 mmHg) quintile of SD of systolic BP, respectively (P trend =0.004). The association was similar when ESRD and a 50% decline in eGFR were analyzed separately, for other measures of visit-to-visit variability of systolic BP, and for visit-to-visit variability of diastolic BP.

Conclusions: Higher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.

Keywords: antihypertensive agents; blood pressure; blood pressure variability; cardiovascular diseases; clinical trial; follow-up studies; glomerular filtration rate; hypertension; kidney failure, chronic; random allocation.

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Figures

Figure 1.
Figure 1.
Summary of analytic cohort formation. ALLHAT, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial; CHD, coronary heart disease; CHF, congestive heart failure.
See this image and copyright information in PMC

Comment in

  • Finding a Signal in the Noise.
    McMullan CJ, Forman JP. McMullan CJ, et al. Clin J Am Soc Nephrol. 2016 Mar 7;11(3):374-6. doi: 10.2215/CJN.00880116. Epub 2016 Feb 18. Clin J Am Soc Nephrol. 2016. PMID: 26912545 Free PMC article. No abstract available.

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