Youbao Li1,2,3,4, Dan Li1,2,3,4, Yun Song5, Lan Gao6, Fangfang Fan6, Binyan Wang1,2,3,4, Min Liang1,2,3,4, Guobao Wang1,2,3,4, Jianping Li6, Yan Zhang6, Xin Xu1,2,3,4, Fan Fan Hou1,2,3,4, Xiaoshu Cheng7, Ningling Sun8, Yingxian Sun9, Lianyou Zhao10, Qijun Wan11, Xiaoming Li12, Junnong Li13, Qinghua Han14, Xiping Xu1,2,3,4,5, Yong Huo6, Xianhui Qin1,2,3,4. 1. Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China. 2. National Clinical Research Center for Kidney Disease, Guangzhou, China. 3. State Key Laboratory of Organ Failure Research, Guangzhou, China. 4. Guangdong Provincial Institute of Nephrology, Guangzhou, China. 5. Beijing Advanced Innovation Center for Food Nutrition and Human Health, The Key Laboratory for Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, China. 6. Department of Cardiology, Peking University First Hospital, Beijing, China. 7. Department of Cardiology, Second Affiliated Hospital, Nanchang University, Nanchang, China. 8. Department of Cardiology, Peking University People's Hospital, Beijing, China. 9. Department of Cardiology, The First Hospital of China Medical University, Shenyang, China. 10. Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, China. 11. Department of Nephrology, Shenzhen Second People's Hospital, Shenzhen, China. 12. Department of Emergency, First People's Hospital of Lianyungang, Lianyungang, China. 13. Department of Cardiology, Weinan Central Hospital, Weinan, China. 14. Department of Cardiology, The First Hospital of Shanxi Medical University, Taiyuan, China.
Abstract
BACKGROUND: Data on the association between visit-to-visit variability (VVV) in blood pressure (BP) and the risk of chronic kidney disease (CKD) in general treated hypertensive patients were limited. We aimed to evaluate the relation of VVV in BP with the development of CKD, and examine any possible effect modifiers in hypertensive patients without prior cardiovascular diseases (CVDs) or CKD. METHODS: This is a post hoc analysis of the Renal Sub-study of the China Stroke Primary Prevention Trial (CSPPT). A total of 10 051 hypertensives without CVD and CKD and with at least six visits of BP measurements from randomization to the 24-month visit were included. The main VVV in BP was expressed as standard deviation (SD). The primary outcome was the development of CKD, defined as a decrease in estimated glomerular filtration rate ≥30% and to a level of <60 mL/min/1.73 m2, or end-stage renal disease. RESULTS: The median treatment duration was 4.4 years. After multivariable adjustment, including baseline systolic blood pressure (SBP) and mean SBP during the first 2-year treatment period, there was a significantly positive relationship of SD of SBP with the risk of CKD development (per SD increment; odds ratio, 1.27; 95% confidence interval: 1.10-1.46). The results were similar for coefficient of variation (CV) of SBP. Results across various subgroups, including age, sex, SBP at baseline, treatment compliance, concomitant antihypertensive medications and mean SBP during the first 24-month treatment period, were consistent. CONCLUSIONS: SBP variability, irrespective of mean BP level, was significantly associated with the development of CKD in general treated hypertensive patients.
BACKGROUND: Data on the association between visit-to-visit variability (VVV) in blood pressure (BP) and the risk of chronic kidney disease (CKD) in general treated hypertensivepatients were limited. We aimed to evaluate the relation of VVV in BP with the development of CKD, and examine any possible effect modifiers in hypertensivepatients without prior cardiovascular diseases (CVDs) or CKD. METHODS: This is a post hoc analysis of the Renal Sub-study of the China Stroke Primary Prevention Trial (CSPPT). A total of 10 051 hypertensives without CVD and CKD and with at least six visits of BP measurements from randomization to the 24-month visit were included. The main VVV in BP was expressed as standard deviation (SD). The primary outcome was the development of CKD, defined as a decrease in estimated glomerular filtration rate ≥30% and to a level of <60 mL/min/1.73 m2, or end-stage renal disease. RESULTS: The median treatment duration was 4.4 years. After multivariable adjustment, including baseline systolic blood pressure (SBP) and mean SBP during the first 2-year treatment period, there was a significantly positive relationship of SD of SBP with the risk of CKD development (per SD increment; odds ratio, 1.27; 95% confidence interval: 1.10-1.46). The results were similar for coefficient of variation (CV) of SBP. Results across various subgroups, including age, sex, SBP at baseline, treatment compliance, concomitant antihypertensive medications and mean SBP during the first 24-month treatment period, were consistent. CONCLUSIONS: SBP variability, irrespective of mean BP level, was significantly associated with the development of CKD in general treated hypertensivepatients.
Authors: Sang Heon Suh; Tae Ryom Oh; Hong Sang Choi; Chang Seong Kim; Kook-Hwan Oh; Joongyub Lee; Yun Kyu Oh; Ji Yong Jung; Kyu Hun Choi; Seong Kwon Ma; Eun Hui Bae; Soo Wan Kim Journal: J Clin Med Date: 2021-12-29 Impact factor: 4.241