BACKGROUND: Recent understanding of the incidence of chronic kidney disease (CKD) has led us to the introduction of national blood pressure (BP) targets aimed at reducing the incidence of end-stage renal failure. The target clinic BP is <140/90 mmHg and <130/80 in patients with significant proteinuria according to UK NICE guidelines. However, the relationship between clinic BP and ambulatory hypotension has not been studied. METHODS: We prospectively collected data regarding cardiovascular risk factors, clinic and 24-h ambulatory blood pressure monitoring (24-h ABPM) in 98 treated patients with CKD stages 3 and 4. RESULTS: The mean percentage of systolic blood pressure (SBP) recordings <100 mmHg was 21.2 +/- 16.2% and of diastolic blood pressure (DBP) recordings <60 mmHg was 19.8 +/- 16.9%. The patients were divided into two groups above and below the median age. The older group had a higher percentage of cardiovascular disease than younger patients (57.1 versus 34.7, P = 0.03) and a lower percentage of primary renal disease (18.4 versus 55.1, P < 0.01). Clinic SBP was higher in the older group (158.4 +/- 20.1 versus 147.2 +/- 17.8 mmHg, P < 0.01) but 24-h ABPM SBP was not different (117.3 +/- 14.7 versus 121.0 +/- 12.8 mmHg, P = 0.19). DBP was lower in the older group for both clinic BP (80.3 +/- 10.2 versus 85.5 +/- 12.3 mmHg, P = 0.03) and 24-h ABPM (69.1 +/- 8.2 versus 76.7 +/- 8.8 mmHg, P = <0.01). There were a higher percentage of systolic (SBP <100 mmHg) and diastolic (DBP<60 mmHg) hypotensive episodes in the older group (21.3 +/- 18.9 versus 13.2 +/- 13.6% P = 0.02 and 21.6 +/- 17.9 versus 8.1 +/- 13.3%, P < 0.01, respectively). CONCLUSIONS: Hypotension was common among treated CKD patients and despite similar clinic SBP, older CKD patients had lower 24-h ABPM DBP and more frequent systolic and diastolic hypotensive episodes. Further research is underway into how this relates to antihypertensive therapy and future outcomes.
BACKGROUND: Recent understanding of the incidence of chronic kidney disease (CKD) has led us to the introduction of national blood pressure (BP) targets aimed at reducing the incidence of end-stage renal failure. The target clinic BP is <140/90 mmHg and <130/80 in patients with significant proteinuria according to UK NICE guidelines. However, the relationship between clinic BP and ambulatory hypotension has not been studied. METHODS: We prospectively collected data regarding cardiovascular risk factors, clinic and 24-h ambulatory blood pressure monitoring (24-h ABPM) in 98 treated patients with CKD stages 3 and 4. RESULTS: The mean percentage of systolic blood pressure (SBP) recordings <100 mmHg was 21.2 +/- 16.2% and of diastolic blood pressure (DBP) recordings <60 mmHg was 19.8 +/- 16.9%. The patients were divided into two groups above and below the median age. The older group had a higher percentage of cardiovascular disease than younger patients (57.1 versus 34.7, P = 0.03) and a lower percentage of primary renal disease (18.4 versus 55.1, P < 0.01). Clinic SBP was higher in the older group (158.4 +/- 20.1 versus 147.2 +/- 17.8 mmHg, P < 0.01) but 24-h ABPM SBP was not different (117.3 +/- 14.7 versus 121.0 +/- 12.8 mmHg, P = 0.19). DBP was lower in the older group for both clinic BP (80.3 +/- 10.2 versus 85.5 +/- 12.3 mmHg, P = 0.03) and 24-h ABPM (69.1 +/- 8.2 versus 76.7 +/- 8.8 mmHg, P = <0.01). There were a higher percentage of systolic (SBP <100 mmHg) and diastolic (DBP<60 mmHg) hypotensive episodes in the older group (21.3 +/- 18.9 versus 13.2 +/- 13.6% P = 0.02 and 21.6 +/- 17.9 versus 8.1 +/- 13.3%, P < 0.01, respectively). CONCLUSIONS:Hypotension was common among treated CKDpatients and despite similar clinic SBP, older CKDpatients had lower 24-h ABPM DBP and more frequent systolic and diastolic hypotensive episodes. Further research is underway into how this relates to antihypertensive therapy and future outcomes.
Authors: Dena E Rifkin; Joseph A Abdelmalek; Cynthia M Miracle; Chai Low; Ryan Barsotti; Phil Rios; Carl Stepnowsky; Zia Agha Journal: Blood Press Monit Date: 2013-02 Impact factor: 1.444
Authors: Maria Udeanu; Giordano Guizzardi; Giuseppe Di Pasquale; Antonio Marchetti; Francesca Romani; Vittorio Dalmastri; Irene Capelli; Lucia Stalteri; Giuseppe Cianciolo; Paola Rucci; Gaetano La Manna Journal: BMC Nephrol Date: 2014-09-17 Impact factor: 2.388
Authors: Jeffrey C Fink; Rebecca M Maguire; Thomas Blakeman; Laurie A Tomlinson; Charles Tomson; Lee-Ann Wagner; Min Zhan Journal: Kidney Med Date: 2022-07-31