Short-term blood pressure variability linked to kidney disease with hypertension
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Among patients with hypertension, short-term blood pressure variability correlated with the development of kidney disease outcomes, such as a decline in eGFR, according to data published in the American Journal of Kidney Diseases.
“The prognostic role of short-term blood pressure variability (BPV) measured using ambulatory blood pressure (BP) monitoring (ABPM) for 24 hours has emerged as a significant indicator for predicting adverse cardiovascular events or mortality in patients,” Jong Hyun Jhee, MD, PhD, from the division of nephrology and department of internal medicine at Gangnam Severance Hospital, Yonsei University College of Medicine, in the Republic of Korea, and colleagues wrote. They added, “Since no effective indicators to provide risk stratification for incident [chronic kidney disease] CKD in hypertensive patients exist to date, this study hypothesized that short-term BPV may have a better risk-stratifying role in predicting kidney dysfunction in hypertensive patients. Therefore, this study aimed to evaluate the clinical significance of short-term BPV obtained from ABPM on the development of CKD in patients with hypertension.”
In a prospective observational cohort study, researchers evaluated 1,173 patients with hypertension from the Cardiovascular and Metabolic Disease Etiology Research Center — High Risk study that took place between 2013 and 2018. Patients had eGFRs of at least 60 mL/min/1.73 m2 and patients included in this study were diagnosed with hypertension.
Researchers used average real variability (ARV) to measure short-term BPV during a 24-hour period.
Researchers conducted multivariable Cox regression analyses to determine the relationship between systolic and diastolic BP-ARV and a kidney disease composite outcome of 30% decline in eGFR from baseline, a new incidence of eGFR less than 60 mL/min/1.73 m2 or onset of urine protein creatine ratio greater than 300 mg/g. Additionally, survival probability was measured using Kaplan-Meier analysis and the log-rank test.
Analyses revealed the highest systolic BP- and diastolic BP-ARV tertiles correlated with an increased risk of the composite kidney disease outcome than the lowest tertiles, regardless of the 24-hour SBP or DBP levels. Researchers observed consistent associations independent of subgroups and when systolic BP- and diastolic BP-ARVs were used as continuous variables.
A total of 271 events of the kidney disease composite outcome happened during a median of 5.4 years. While systolic BP- and diastolic BP-ARV tertiles were associated with a risk of the kidney disease, the other measures of short-term BPV, such as standard deviation, coefficient variation and dipping patterns did not correspond with incident CKD.
Researchers wrote that limitations of the study included lack of changes in antihypertensive medication during the follow-up.
“In this study, high systolic BP- and diastolic BP-ARV levels were associated with increased 24-hour, daytime and nighttime pulse pressure (PP) levels. Elevated PP is a surrogate marker of arterial stiffness, which is closely related to diurnal BP fluctuations including short-term BPV. Increased arterial stiffness and short-term BPV share the pathophysiology of reduced baroreceptor sensitivity or sympathetic nervous system activation. Consequently, concomitant increases in BPV and arterial stiffness may exacerbate target organ damage including decline in kidney function,” Jhee and colleagues wrote. They added, “Further longitudinal studies are needed to evaluate the effect of high short-term BPVs with cardiovascular risks on renal outcome.”
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