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. 2019 Feb 7;14(2):233-240.
doi: 10.2215/CJN.04030318. Epub 2019 Jan 2.

Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients

Francesca Mallamaci  1 , Giovanni Tripepi  1 , Graziella D'Arrigo  1 , Silvio Borrelli  2 , Carlo Garofalo  2 , Giovanna Stanzione  2 , Michele Provenzano  2 , Luca De Nicola  2 , Giuseppe Conte  2 , Roberto Minutolo  2 , Carmine Zoccali  2
Affiliations

Blood Pressure Variability, Mortality, and Cardiovascular Outcomes in CKD Patients

Francesca Mallamaci et al. Clin J Am Soc Nephrol. .

Abstract

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.

Keywords: Ambulatory Care; Prognosis; Renal Insufficiency, Chronic; Systole; blood pressure; cardiovascular; chronic kidney disease; hypertension; mortality risk.

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Figures

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Graphical abstract
Figure 1.
Figure 1.
Mutual association of long- and short-term BP and associations of the same variabilities with systolic and pulse pressure. (Upper panels) Association of visit-to-visit systolic BP variability (SD) with short-term systolic BP variability (weighted SD; left panel), average systolic BP (center panel), and pulse pressure (right panel) across visits. The lower panels show the relationship of average 24-hour systolic BP (left panel) and 24-hour pulse pressure (right panel) with short-term BP variability (weighted SD).
See this image and copyright information in PMC

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