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Yang L, Li J, Wei W, Pu Y, Zhang L, Cui T, Ma L, Wang B, Zhao Y, Fu P. Blood Pressure Variability and the Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis. J Gen Intern Med 2023; 38:1272-1281. [PMID: 36650323 PMCID: PMC10110830 DOI: 10.1007/s11606-022-08001-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Blood pressure variability (BPV) is a risk factor for poor prognosis including cardiovascular events, chronic kidney disease, and mortality, independent of elevated BP. METHODS We searched PubMed/Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 23, 2022. Cohort studies reporting the association between BPV and chronic kidney disease (CKD) progression were selected. Hazard ratios were pooled using a random-effects model. Meta-regression, subgroup analyses, and sensitivity analyses were conducted. RESULTS A total of 23 studies were included in this systematic review and meta-analysis. Increased BPV was associated with progression of CKD (HR: 1.21, 95% CI: 1.09-1.33) and incidence of ESRD (HR: 1.08, 95% CI: 1.08-1.30). Among the different BPV metrics, high variation independent of mean (VIM), coefficient of variation (CV), standard deviation (SD), and average real variability (ARV) were indicated as predictors of CKD progression. DISCUSSION Increased BPV was associated with CKD progression.
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Affiliation(s)
- Letian Yang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Jian Li
- West China School of Medicine, Sichuan University, Chengdu, 610041, China
| | - Wei Wei
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Yajun Pu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Ling Zhang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Tianlei Cui
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Liang Ma
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Bo Wang
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
| | - Yuliang Zhao
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China.
| | - Ping Fu
- Division of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, China
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Wang J, Shen H, Liu J, Xiao C, Chen C, Teng H, Hu J, Yin J. School-based surveillance on visit-to-visit blood pressure variability and high blood pressure in children and adolescents. BMC Cardiovasc Disord 2021; 21:141. [PMID: 33731001 PMCID: PMC7967982 DOI: 10.1186/s12872-021-01947-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/28/2021] [Indexed: 01/09/2023] Open
Abstract
Background The predictive importance of visit-to-visit blood pressure variability (VVV) for high blood pressure (HBP) in a pediatric population has been largely unsettled. We aimed to evaluate it based on Health Promotion Program for Children and Adolescents (HPPCA), a school-based surveillance conducted from 2012 to 2018 in Suzhou, China. Methods A total of 330,618 participants had BP measurement in 2018 and ≥ 3 BP records during 2012–2017, were recruited from HPPCA. Absolute BP values (in mmHg) were converted into age-, sex- and height- normalized z-scores. VVV was expressed as standard deviation (SD), coefficient of variation (CV) or average real variability (ARV) of BP z-scores during 2012–2017. Logistic regression models were used to assess the associations between VVV and HBP in 2018. Results In 2018, 42,554 (12.87%) subjects were defined as HBP. VVV, except for SBP-CV and DBP-CV, was significantly higher in the HBP group than normotensives group. After adjusting for covariates including mean BP values from 2012 to 2017, SBP-SD, SBP-ARV, DBP-SD and DBP-ARV, increased the risk of HBP by 5.70 [95% confidence interval (95% CI) 5.54–5.87], 4.10 (95% CI 4.01–4.20), 4.70 (95% CI 4.50–4.90) and 3.39 (95% CI 3.28–3.50) times, respectively. Notably, SBP-SD significantly improved risk discrimination of HBP based on other risk variables (c-statistics, net reclassification index and integrated discrimination improvement significantly increased). Conclusions Higher SD or ARV of BP, was independently related with higher probability of HBP in Chinese pediatric population. SBP-SD could be potentially helpful for detecting HBP. Future researches investigating the predictive value of VVV are warrant. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-01947-1.
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Affiliation(s)
- Jiaxiang Wang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Hui Shen
- Suzhou Center for Disease Prevention and Control, 72 Sanxiang Road, Suzhou, 215004, Jiangsu, China
| | - Jieyu Liu
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Chengqi Xiao
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Cailong Chen
- Children Health Management Center, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Haoyue Teng
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China
| | - Jia Hu
- Suzhou Center for Disease Prevention and Control, 72 Sanxiang Road, Suzhou, 215004, Jiangsu, China.
| | - Jieyun Yin
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, Jiangsu, China.
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Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. 24-Hour Ambulatory Blood Pressure Variability in Children with Obstructive Sleep Apnea. Laryngoscope 2021; 131:2126-2132. [PMID: 33599298 DOI: 10.1002/lary.29455] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/06/2021] [Accepted: 01/29/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To evaluate blood pressure (BP) variability in 24-hour ambulatory BP monitoring in children with obstructive sleep apnea (OSA). STUDY DESIGN Case series study. METHODS Children aged 4 to 16 years with clinical symptoms were recruited in a tertiary medical center. Overnight polysomnography and 24-hour recordings of ambulatory BP were performed for each child. The severity of OSA was classified as primary snoring (apnea-hypopnea index [AHI] < 1), mild OSA (1 ≤ AHI < 5), moderate OSA (10 > AHI ≥ 5), and severe OSA (AHI ≥ 10). The standard deviation of mean BP was used as an indicator of BP variability. RESULTS A total of 550 children were included (mean age: 7.6 years; 70% were boys; 20% were obese). Compared with the children with primary snoring, children with severe OSA exhibited significantly higher nighttime systolic BP (108.0 vs. 100.5 mmHg, P < .001), nighttime diastolic BP (58.9 vs 55.6 mmHg, P = .002), nighttime mean arterial pressure (75.3 vs. 70.5 mmHg, P < .001), nighttime systolic BP load (40.5% vs. 25.0%, P < .001), nighttime diastolic BP load (25.3% vs. 12.9%, P < .001), and nighttime systolic BP variability (11.4 vs. 9.6, P = .001). Multiple linear regression analyses revealed an independent association between AHI and nighttime systolic BP variability (regression coefficient = 0.31, 95% CI = 0.06-0.56, P = .015) after adjustment for age, gender, adiposity, and hypertensive status. CONCLUSIONS OSA in children is associated with increased BP and BP variability. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2126-2132, 2021.
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Affiliation(s)
- Kun-Tai Kang
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.,Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chin Weng
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Lin Lee
- Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University Hospital, Taipei, Taiwan.,Sleep Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Otolaryngology, College of Medicine, National Taiwan University, Taipei, Taiwan
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