J Korean Med Sci.  2014 Jul;29(7):957-964. 10.3346/jkms.2014.29.7.957.

The Clinical Association of the Blood Pressure Variability with the Target Organ Damage in Hypertensive Patients with Chronic Kidney Disease

• Ryu J
• Cha RH
• Kim DK
• Lee JH
• Yoon SA
• Ryu DR
• Oh JE
• Kim S
• Han SY
• Lee EY
• Kim YS
• APrODiTe investigators

• KMID: 1789955
• DOI: http://doi.org/10.3346/jkms.2014.29.7.957

Abstract

It is known that blood pressure variability (BPV) can independently affect target organ damage (TOD), even with normal blood pressure. There have been few studieson chronic kidney disease (CKD) patients. We evaluated the relationship between BPV and TOD in a cross-sectional, multicenter study on hypertensive CKD patients. We evaluated 1,173 patients using 24-hr ambulatory blood pressure monitoring. BPV was defined as the average real variability, with a mean value of the absolute differences between consecutive readings of systolic blood pressure. TOD was defined as left ventricular hypertrophy (LVH) (by the Romhilt-Estes score > or =4 in electrocardiography) and kidney injury (as determined from an estimated glomerular filtration rate [eGFR]<30 mL/min/1.73 m2 and proteinuria).The mean BPV of the subjects was 15.9+/-4.63 mmHg. BPV displayed a positive relationship with LVH in a univariate analysis and after adjustment for multi-variables (odds ratio per 1 mmHg increase in BPV: 1.053, P=0.006). In contrast, BPV had no relationship with kidney injury. These data suggest that BPV may be positively associated with LVH in hypertensive CKD patients.

Keyword

Blood Pressure Variability; Kidney Failure, Chronic; Hypertension; Hypertrophy, Left Ventricular; Target Organ Damage

MeSH Terms

Adult
Aged
Blood Pressure/*physiology
Blood Pressure Monitoring, Ambulatory
Cross-Sectional Studies
Electrocardiography
Female
Glomerular Filtration Rate
Humans
Hypertension/*complications/*diagnosis
Hypertrophy, Left Ventricular/*physiopathology
Kidney/injuries
Male
Middle Aged
Odds Ratio
Proteinuria/complications
Renal Insufficiency, Chronic/*complications/*diagnosis

Figure

• 

  Fig. 1 Odds ratio for left ventricular hypertrophy (LVH) by systolic blood pressure variability (BPV). *Logarithm of odds ratio.

• 

  Fig. 2 The association* of blood pressure variability (BPV) and left ventricular hypertrophy (LVH) by subgroup. †ACEI/ARB, patients receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. *Logistic regression analysis: adjusted for age, sex, smoking, anti-hypertension medication use, 24-hr mean systolic blood pressure, diabetes, exercise, eGFR, and proteinuria (spot urine protein/creatinineratio [≥ 300 mg/g]). ‡Odds ratio; §95% confidence interval; ∥P value for the interaction between corresponding subgroups, as determined by logistic regression in the multivariable analysis.

• 

  Fig. 3 Odds ratio for left ventricular hypertrophy by systolic blood pressure variability (BPV) by the status of hypertension group. *Logarithm of odds ratio; †Hypertension groups by degree of controlled blood pressure (BP) (mmHg): True controlled group: Office BP (mmHg) < 140/80 and 24-hr BP < 135/85 (day) and 120/70 (night). White-coat effect group: Office BP (mmHg) ≥ 140/80 and 24-hr BP < 135/85 (day) and 120/70 (night). Masked hypertension group: Office BP (mmHg) < 140/80 and 24-hr BP ≥ 135/85 (day) or 120/70 (night). Sustained hypertension group: Office BP (mmHg) ≥ 140/80 and 24-hr BP ≥ 135/85 (day) and 120/70 (night). P value in each group: True controlled group, P = 0.055; White-coat effect group, P = 0.006; Masked hypertension group, P = 0.338; Sustained hypertension group, P = 0.077.

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