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Pannier B, Thomas F, Hanon O, Czernichow S, Lemogne C, Simon T, Simon JM, Danchin N. Individual 6-year systolic blood pressure change and impact on cardiovascular mortality in a French general population. J Hum Hypertens 2015; 30:18-23. [PMID: 26016599 DOI: 10.1038/jhh.2015.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 03/09/2015] [Accepted: 04/09/2015] [Indexed: 11/09/2022]
Abstract
Impact of blood pressure (BP) visit-to-visit variability remains controversial for untreated hypertensives and for normotensive subjects. Association between 6-year systolic BP change and all-cause and cardiovascular (CVD) mortality was studied in general primary care population including untreated hypertensive and normotensive subjects. Normotensive individuals and untreated high BP patients (40,926 and 14,283, respectively) had two check-ups (interval: 5.8±2.2 years) at the IPC center (Paris). Follow-up was 6.1±3.2 years: 1131 people died, 114 from CVD causes. Systolic BP (SBP) change was assessed by tertiles of absolute differences between V1 and V2, and the relationship with mortality was analysed with multivariate Cox models (hazard ratio (HR), 95% confidence interval (CI)) including V1 or V2 parameters notably SBP. Adjusting for V1 variables, mortality was associated with SBP change, for the entire population (all-cause: HR=1.15 (95%: 1.01-1.30) and CVD: HR=1.95 (95%: 1.25-3.05)) and in hypertensive individuals: (HR=1.31 (95%: 1.08-1.59) and HR=2.51 (95%: 1.34-4.72), respectively). Adjustments for V2 variables gave similar results. For those who were normotensive at V1, the associations were not significant. In this primary care population, individual long-term visit-to-visit change of BP is an independent predictor of all-cause mortality in hypertensive individuals but not in those with normal BP.
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Affiliation(s)
- B Pannier
- Centre IPC, Paris, France.,Hopital Manhès, Fleury-Merogis, France
| | | | - O Hanon
- Centre IPC, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.,Hopital Broca, APHP, Paris, France
| | - S Czernichow
- Hopital Ambroise Paré, APHP, Université Paris Ile de France Ouest, Boulogne, France
| | - C Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.,Hôpitaux Universitaires Paris Ouest, APHP, Paris, France.,Inserm U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - T Simon
- Hopital Saint Antoine, APHP, Université Pierre et Marie Curie, Paris, France
| | - J-M Simon
- Hopital Pitié Salpétrière, APHP, Paris, France
| | - N Danchin
- Centre IPC, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, Paris, France.,Hôpitaux Universitaires Paris Ouest, APHP, Paris, France
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52
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Medication adherence and visit-to-visit variability of systolic blood pressure in African Americans with chronic kidney disease in the AASK trial. J Hum Hypertens 2015; 30:73-8. [PMID: 25833706 PMCID: PMC4592365 DOI: 10.1038/jhh.2015.26] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 02/05/2015] [Accepted: 02/26/2015] [Indexed: 01/13/2023]
Abstract
Lower adherence to antihypertensive medications may increase visit-to-visit variability of blood pressure (VVV of BP), a risk factor for cardiovascular events and death. We used data from the African American Study of Kidney Disease and Hypertension (AASK) trial to examine whether lower medication adherence is associated with higher systolic VVV of BP in African Americans with hypertensive chronic kidney disease (CKD). Determinants of VVV of BP were also explored. AASK participants (n=988) were categorized by self-report or pill count as having perfect (100%), moderately high (75-99%), moderately low (50-74%) or low (<50%) proportion of study visits with high medication adherence over a 1-year follow-up period. We used multinomial logistic regression to examine determinants of medication adherence, and multivariable-adjusted linear regression to examine the association between medication adherence and systolic VVV of BP, defined as the coefficient of variation or the average real variability (ARV). Participants with lower self-reported adherence were generally younger and had a higher prevalence of comorbid conditions. Compared with perfect adherence, moderately high, moderately low and low adherence was associated with 0.65% (±0.31%), 0.99% (±0.31%) and 1.29% (±0.32%) higher systolic VVV of BP (defined as the coefficient of variation) in fully adjusted models. Results were qualitatively similar when using ARV or when using pill counts as the measure of adherence. Lower medication adherence is associated with higher systolic VVV of BP in African Americans with hypertensive CKD; efforts to improve medication adherence in this population may reduce systolic VVV of BP.
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Tai C, Sun Y, Dai N, Xu D, Chen W, Wang J, Protogerou A, van Sloten TT, Blacher J, Safar ME, Zhang Y, Xu Y. Prognostic significance of visit-to-visit systolic blood pressure variability: a meta-analysis of 77,299 patients. J Clin Hypertens (Greenwich) 2015; 17:107-15. [PMID: 25644682 PMCID: PMC8031983 DOI: 10.1111/jch.12484] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/02/2014] [Accepted: 11/04/2014] [Indexed: 12/15/2022]
Abstract
In recent clinical investigations, visit-to-visit systolic blood pressure (SBP) variability was proven as a predictor of cardiovascular events and all-cause mortality. However, inconsistent results exist in this association. A meta-analysis of 13 prospective studies was conducted to evaluate the prognostic value of visit-to-visit SBP variability by different parameters in 77,299 patients with a mean follow-up of 6.3 years. The pooled age- and mean SBP-adjusted hazard ratios (HRs) for all-cause mortality were 1.03 (95% confidence interval [CI], 1.02-1.04; P<.001) per 1-mm Hg increase in SBP standard deviation (SD) and 1.04 (1.02-1.06, P<.001) per 1% in SBP coefficient of variation, and the corresponding values of cardiovascular mortality were 1.10 (1.02-1.17, P<.001) and 1.01 (0.99-1.03, P=.32), respectively. Moreover, a 1-mm Hg increase in SD was significantly associated with stroke, with an HR of 1.02 (1.01-1.03, P<.001). Visit-to-visit SBP variability, independent of age and mean SBP, is a predictor of cardiovascular and all-cause mortality and stroke.
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Affiliation(s)
- Chenhui Tai
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Yuxi Sun
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Neng Dai
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Dachun Xu
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Wei Chen
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Jiguang Wang
- Shanghai Institute of HypertensionRuijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
| | - Athanase Protogerou
- Hypertension Center1st Department of Propaedeutic MedicineLaiko HospitalMedical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - Thomas T. van Sloten
- Department of MedicineCardiovascular Research Institute Maastricht, and School for Nutrition, Toxicology and MetabolismMaastricht University Medical CentreMaastrichtThe Netherlands
| | - Jacques Blacher
- Diagnosis and Therapeutic CenterHôtel‐Dieu HospitalAP‐HPParis Descartes UniversityParisFrance
| | - Michel E. Safar
- Diagnosis and Therapeutic CenterHôtel‐Dieu HospitalAP‐HPParis Descartes UniversityParisFrance
| | - Yi Zhang
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
| | - Yawei Xu
- Department of CardiologyShanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina
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54
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Okada T, Wada T, Nagaoka Y, Kanno Y. Association between visit-to-visit clinic blood pressure variability and home blood pressure variability in patients with chronic kidney disease. Ren Fail 2015; 37:446-51. [DOI: 10.3109/0886022x.2014.996730] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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55
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Jo HA, An JN, Lee JP, Oh KH, Lim CS, Oh YK. Visit-to-Visit Variability in Systolic Blood Pressure Is a Risk Factor for Rapid Loss of Residual Renal Function in Peritoneal Dialysis Patients. TOHOKU J EXP MED 2015; 235:295-304. [DOI: 10.1620/tjem.235.295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hyung Ah Jo
- Department of Internal Medicine, Seoul National University Hospital
| | - Jung Nam An
- Department of Internal Medicine, Seoul National University Boramae Medical Center
- Department of Internal Medicine, Seoul National University Hospital
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center
- Department of Internal Medicine, Seoul National University Hospital
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University Hospital
| | - Chun Soo Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center
- Department of Internal Medicine, Seoul National University Hospital
| | - Yun Kyu Oh
- Department of Internal Medicine, Seoul National University Boramae Medical Center
- Department of Internal Medicine, Seoul National University Hospital
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56
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McMullan CJ, Lambers Heerspink HJ, Parving HH, Dwyer JP, Forman JP, de Zeeuw D. Visit-to-Visit Variability in Blood Pressure and Kidney and Cardiovascular Outcomes in Patients With Type 2 Diabetes and Nephropathy: A Post Hoc Analysis From the RENAAL Study and the Irbesartan Diabetic Nephropathy Trial. Am J Kidney Dis 2014; 64:714-22. [DOI: 10.1053/j.ajkd.2014.06.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 06/02/2014] [Indexed: 01/13/2023]
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Diaz KM, Tanner RM, Falzon L, Levitan EB, Reynolds K, Shimbo D, Muntner P. Visit-to-visit variability of blood pressure and cardiovascular disease and all-cause mortality: a systematic review and meta-analysis. Hypertension 2014; 64:965-82. [PMID: 25069669 DOI: 10.1161/hypertensionaha.114.03903] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Visit-to-visit variability of blood pressure (BP) has been associated with cardiovascular disease (CVD) and mortality in some but not all studies. We conducted a systematic review and meta-analysis to examine the association between visit-to-visit variability of BP and CVD and all-cause mortality. Medical databases were searched through June 4, 2014, for studies meeting the following eligibility criteria: adult participants; BP measurements at ≥3 visits; follow-up for CVD, coronary heart disease, stroke, or mortality outcomes; events confirmed via database, death certificate, or event ascertainment committee; and adjustment for confounders. Data were extracted by 2 reviewers and pooled using a random-effects model. Overall, 8870 abstracts were identified of which 37 studies, representing 41 separate cohorts, met inclusion criteria. Across studies, visit-to-visit variability of systolic BP and diastolic BP showed significant associations with outcomes in 181 of 312 (58.0%) and 61 of 188 (32.4%) analyses, respectively. Few studies provided sufficient data for pooling risk estimates. For each 5 mm Hg higher SD of systolic BP, the pooled hazard ratio for stroke across 7 cohorts was 1.17 (95% confidence interval [CI], 1.07-1.28), for coronary heart disease across 4 cohorts was 1.27 (95% CI, 1.07-1.51), for CVD across 5 cohorts was 1.12 (95% CI, 0.98-1.28), for CVD mortality across 5 cohorts was 1.22 (95% CI, 1.09-1.35), and for all-cause mortality across 4 cohorts was 1.20 (95% CI, 1.05-1.36). In summary, modest associations between visit-to-visit variability of BP and CVD and all-cause mortality are present in published studies. However, these findings are limited by the small amount of data available for meta-analysis.
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Affiliation(s)
- Keith M Diaz
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.).
| | - Rikki M Tanner
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Louise Falzon
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Emily B Levitan
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Kristi Reynolds
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Daichi Shimbo
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
| | - Paul Muntner
- From the Department of Medicine, Columbia University Medical Center, New York, NY (K.M.D., L.F., D.S.); Department of Epidemiology, University of Alabama at Birmingham (R.M.T., E.B.L., P.M.); and Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA (K.R.)
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58
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Yokota K, Fukuda M, Matsui Y, Kario K, Kimura K. Visit-to-visit variability of blood pressure and renal function decline in patients with diabetic chronic kidney disease. J Clin Hypertens (Greenwich) 2014; 16:362-6. [PMID: 24712921 PMCID: PMC8032038 DOI: 10.1111/jch.12293] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/21/2014] [Accepted: 01/23/2014] [Indexed: 11/27/2022]
Abstract
The authors previously reported that the visit-to-visit variability of blood pressure is correlated with renal function decline in nondiabetic chronic kidney disease. Little is known about the association between visit-to-visit variability and renal function decline in patients with diabetic chronic kidney disease. The authors retrospectively studied 69 patients with diabetic chronic kidney disease stage 3a, 3b, or 4. The standard deviation and coefficient of variation of blood pressure in 12 consecutive visits were defined as visit-to-visit variability of blood pressure. The median observation period was 32 months. In univariate correlation, the standard deviation and coefficient of variation of blood pressure were not significantly associated with the slope of estimated glomerular filtration rate. There was no significant association between the visit-to-visit variability of blood pressure and renal function decline in patients with diabetic chronic kidney disease, in contrast with our previous study of nondiabetic patients with chronic kidney disease.
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Affiliation(s)
- Kei Yokota
- Division of Cardiovascular MedicineDepartment of MedicineSchool of MedicineJichi Medical UniversityTochigiJapan
- Department of NephrologyIwakuni Medical CenterYamaguchiJapan
- Department of Nephrology and HypertensionSchool of MedicineSt. Marianna UniversityKanagawaJapan
| | | | - Yoshio Matsui
- Department of Internal MedicineIwakuni Medical CenterYamaguchiJapan
| | - Kazuomi Kario
- Division of Cardiovascular MedicineDepartment of MedicineSchool of MedicineJichi Medical UniversityTochigiJapan
| | - Kenjiro Kimura
- Department of Nephrology and HypertensionSchool of MedicineSt. Marianna UniversityKanagawaJapan
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59
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Leisman D, Meyers M, Schnall J, Chorny N, Frank R, Infante L, Sethna CB. Blood Pressure Variability in Children With Primary vs Secondary Hypertension. J Clin Hypertens (Greenwich) 2014; 16:437-41. [DOI: 10.1111/jch.12322] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/06/2014] [Accepted: 03/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel Leisman
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Melissa Meyers
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Jeremy Schnall
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Nataliya Chorny
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Rachel Frank
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Lulette Infante
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
| | - Christine B. Sethna
- Division of Pediatric Nephrology; Department of Pediatrics; Cohen Children's Medical Center of New York; New Hyde Park NY
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Saeed A, DiBona GF, Grimberg E, Nguy L, Mikkelsen MLN, Marcussen N, Guron G. High-NaCl diet impairs dynamic renal blood flow autoregulation in rats with adenine-induced chronic renal failure. Am J Physiol Regul Integr Comp Physiol 2014; 306:R411-9. [DOI: 10.1152/ajpregu.00383.2013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This study examined the effects of 2 wk of high-NaCl diet on kidney function and dynamic renal blood flow autoregulation (RBFA) in rats with adenine-induced chronic renal failure (ACRF). Male Sprague-Dawley rats received either chow containing adenine or were pair-fed an identical diet without adenine (controls). After 10 wk, rats were randomized to either remain on the same diet (0.6% NaCl) or to be switched to high 4% NaCl chow. Two weeks after randomization, renal clearance experiments were performed under isoflurane anesthesia and dynamic RBFA, baroreflex sensitivity (BRS), systolic arterial pressure variability (SAPV), and heart rate variability were assessed by spectral analytical techniques. Rats with ACRF showed marked reductions in glomerular filtration rate and renal blood flow (RBF), whereas mean arterial pressure and SAPV were significantly elevated. In addition, spontaneous BRS was reduced by ∼50% in ACRF animals. High-NaCl diet significantly increased transfer function fractional gain values between arterial pressure and RBF in the frequency range of the myogenic response (0.06–0.09 Hz) only in ACRF animals (0.3 ± 4.0 vs. −4.4 ± 3.8 dB; P < 0.05). Similarly, a high-NaCl diet significantly increased SAPV in the low-frequency range only in ACRF animals. To conclude, a 2-wk period of a high-NaCl diet in ACRF rats significantly impaired dynamic RBFA in the frequency range of the myogenic response and increased SAPV in the low-frequency range. These abnormalities may increase the susceptibility to hypertensive end-organ injury and progressive renal failure by facilitating pressure transmission to the microvasculature.
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Affiliation(s)
- Aso Saeed
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Gerald F. DiBona
- Departments of Internal Medicine and Molecular Physiology and Biophysics, Department of Veterans Affairs Medical Center and University of Iowa Carver College of Medicine, Iowa City, Iowa; and
| | - Elisabeth Grimberg
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Lisa Nguy
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | | | - Niels Marcussen
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Gregor Guron
- Department of Molecular and Clinical Medicine/Nephrology, Institute of Medicine, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Abstract
PURPOSE OF REVIEW To summarize the available evidence on whether a lower blood pressure (BP) treatment target can ameliorate the progression of nondiabetic chronic kidney disease (CKD), and prevent cardiovascular events in CKD patients. RECENT FINDINGS The three prospective, randomized controlled trials which addressed the question of progression of CKD suggest that a lower BP treatment goal (<130/80 mmHg) may lead to better preservation of renal function, but only in those patients with proteinuria of more than 300 mg/day. However, the evidence is not conclusive. We are not aware of adequately powered, randomized trials that have assessed the efficacy of lower target BP levels for the prevention of cardiovascular events specifically in nondiabetic CKD patients. The available circumstantial evidence (e.g., subgroup analyses of CKD patients in cardiovascular trials) fails to reveal a clear benefit of a lower BP goal. SUMMARY There is currently no convincing evidence to recommend a lower than standard BP treatment target of less than 140/90 mmHg for all patients with nondiabetic CKD. A lower treatment target of less than 130/80 mmHg may delay renal disease progression but only in patients with proteinuria.
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Suttorp MM, Hoekstra T, Mittelman M, Ott I, Franssen CFM, Dekker FW. Effect of erythropoiesis-stimulating agents on blood pressure in pre-dialysis patients. PLoS One 2013; 8:e84848. [PMID: 24391978 PMCID: PMC3877353 DOI: 10.1371/journal.pone.0084848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 11/19/2013] [Indexed: 11/29/2022] Open
Abstract
Introduction Erythropoiesis-Stimulating Agents (ESA) are hypothesized to increase cardiovascular mortality in patients with chronic kidney disease. One of the proposed mechanisms is the elevation of blood pressure (BP) by ESA. Therefore, we aimed to determine whether the use of ESA was associated with antihypertensive treatment and higher BP. Materials and Methods In this cohort 502 incident pre-dialysis patients were included who started specialized pre-dialysis care in 25 clinics in the Netherlands. Data on medication including ESA use and dose, co-morbidities and BP were routinely collected every 6 months. Antihypertensive treatment and BP were compared for patients with and without ESA at baseline. Differences in antihypertensive medication and BP during pre-dialysis care were estimated with linear mixed models adjusted for age, sex, body mass index, cardiovascular disease, diabetes mellitus and estimated glomerular filtration rate. Results At baseline, 95.6% of patients with ESA were treated with antihypertensive medication and 73.1% of patients without ESA. No relevant difference in BP was found. During pre-dialysis care patients with ESA used 0.77 (95% CI 0.63;0.91) more classes of antihypertensive drugs. The adjusted difference in systolic blood pressure (SBP) was −0.3 (95% CI −2.7;2.0) mmHg and in diastolic blood pressure (DBP) was −1.0 (95% CI −2.1;0.3) mmHg for patients with ESA compared to patients without ESA. Adjusted SBP was 3.7 (95% CI −1.6;9.0) mmHg higher in patients with a high ESA dose compared to patients with a low ESA dose. Conclusions Our study confirms the hypertensive effect of ESA, since ESA treated patients received more antihypertensive agents. However, no relevant difference in BP was found between patients with and without ESA, thus the increase in BP seems to be controlled for by antihypertensive medication.
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Affiliation(s)
- Marit M. Suttorp
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Tiny Hoekstra
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Moshe Mittelman
- Department of Medicine, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Ilka Ott
- Deutsches Herzzentrum der Technischen Universität München, München, Germany
| | - Casper F. M. Franssen
- Department of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Friedo W. Dekker
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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