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Short‐Term Systolic Blood Pressure Variability and Kidney Disease Progression in Patients With Chronic Kidney Disease: Results From C‐STRIDE

2020; Wiley; Volume: 9; Issue: 12 Linguagem: Inglês

10.1161/jaha.120.015359

2047-9980

Qin Wang, Yu Wang, Jinwei Wang, Luxia Zhang, Ming‐Hui Zhao, Xiaoqin Wang, Jun Yuan, Qiaoling Zhou, Qiongjing Yuan, Menghua Chen, Xiaoling Zhou, Shuxia Fu, Shaomei Li, Yan Zha, Rongsai Huang, Zhangsuo Liu, Jun Zhang, Li Wang, Lei Pu, Jian Liu, Suhua Li, Zuying Xiong, Wei Liang, Jinghong Zhao, Jiao Mu, Xiyan Lian, Yunjuan Liao, Hua Gan, Liping Liao, Rong Wang, Zhimei Lv, Yunhua Liao, Ling Pan, Xiaoping Yang, Zhifeng Lin, Zongwu Tong, Yun Zhu, Qiang He, Fuquan Wu, Rong Li, Kai Rong, Caili Wang, Yanhui Zhang, Yue Wang, Wen Tang, Hua Wu, Ban Zhao, Rongshan Li, Lihua Wang, Detian Li, Feng Du, Yonggui Wu, Wei Zhang, Shan Lin, Pengcheng Xu, Hongli Lin, Zhao Hu, Fei Pei, Haisong Zhang, Yan Gao, Luying Sun, Xia Li, Wenke Wang, Fengling Lv, Deguang Wang, Xuerong Wang, Dongmei Xu, Lijun Tang, Yingchun Ma, Tingting Wang, Ping Fu, Tingli Wang, Changying Xing, Chengning Zhang, Xudong Xu, Haidong He, Xiaohui Liao, Shuqin Xie, Guicai Hu, Lan Huang,

Cardiovascular Health and Disease Prevention

Background It is unclear whether short‐term blood pressure variability is associated with renal outcomes in patients with chronic kidney disease. Methods and Results This study analyzed data from participants in the C‐ STRIDE (Chinese Cohort Study of Chronic Kidney Disease) who had chronic kidney disease stages 1 to 4. Short‐term blood pressure variability was measured by calculating the weighted SD (w‐ SD ) of systolic blood pressure ( SBP ). Renal outcomes were defined as dialysis initiation and/or transplantation. Risk factors associated with w‐ SD of SBP were evaluated by linear regression. Associations of short‐term SBP variability with renal outcomes were evaluated by Cox regression. In total, 1421 patients with chronic kidney disease were included in this study (mean age, 49.4±13.6 years; 56.2% men; estimated glomerular filtration rate, 50.5±29.3 mL/min per 1.73 m 2 ; proteinuria, 0.9 [0.3–2.0] g/d). Mean w‐ SD of SBP was 12.6±4.4 mm Hg. w‐ SD of SBP was independently associated with older age, 24‐hour SBP , blood pressure circadian pattern, and angiotensin II receptor blocker treatment. During a median follow‐up of 4.9 years, 237 patients developed renal outcomes (37.01 per 1000 patient‐years). The incidence rate increased across the quartiles of w‐ SD (log‐rank P =0.005). w‐ SD of SBP was associated with an increased risk of renal outcomes, both as a continuous variable (hazard ratio [HR], 1.47; 95% CI, 1.09–1.99) and as a categorical variable (quartile 4 versus quartile 1: HR, 1.60; 95% CI, 1.08–2.36), independent of 24‐hour SBP , daytime SBP , and nighttime SBP . Conclusions Short‐term SBP was independently associated with the risk of dialysis initiation and/or transplantation in patients with chronic kidney disease .