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Prevalence of ambulatory hypotension in elderly patients with CKD stages 3 and 4

Laurie A Tomlinson1, Stephen G Holt, Allison R Leslie

  • 1Brighton and Sussex Medical School, Audrey Emerton Building, Brighton, East Sussex, BN2 5BE, UK. ltomlinson@doctors.org.uk

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|July 21, 2009
PubMed

Insights

Hypotension is common in treated chronic kidney disease (CKD) patients. Older CKD patients experience more hypotensive episodes, particularly diastolic hypotension, despite similar clinic blood pressure readings.

Area of Science:

  • Nephrology
  • Cardiology
  • Geriatrics

Background:

  • National blood pressure (BP) targets aim to reduce end-stage renal failure in chronic kidney disease (CKD).
  • UK NICE guidelines recommend target clinic BP <140/90 mmHg, or <130/80 mmHg with proteinuria.
  • The link between clinic BP and ambulatory hypotension in CKD patients remains understudied.

Purpose of the Study:

  • To investigate the relationship between clinic blood pressure and 24-hour ambulatory blood pressure monitoring (ABPM) in treated CKD patients.
  • To identify potential differences in BP control and hypotensive episodes between younger and older CKD patients.

Main Methods:

  • Prospective data collection in 98 treated patients with CKD stages 3 and 4.
  • Assessment of cardiovascular risk factors, clinic BP, and 24-h ABPM.
  • Comparison of BP parameters and hypotensive episodes between age groups (above and below median age).

Main Results:

  • Mean systolic blood pressure (SBP) recordings <100 mmHg occurred in 21.2% and diastolic BP (DBP) <60 mmHg in 19.8% of patients.
  • Older CKD patients had higher cardiovascular disease rates (57.1% vs 34.7%) and lower primary renal disease rates (18.4% vs 55.1%).
  • Older patients exhibited higher clinic SBP (158.4 vs 147.2 mmHg) but similar 24-h ABPM SBP (117.3 vs 121.0 mmHg). Older patients had lower clinic DBP (80.3 vs 85.5 mmHg) and 24-h ABPM DBP (69.1 vs 76.7 mmHg), with more frequent hypotensive episodes (SBP <100 mmHg: 21.3% vs 13.2%; DBP <60 mmHg: 21.6% vs 8.1%).

Conclusions:

  • Hypotension is prevalent in treated CKD patients.
  • Older CKD patients demonstrate lower 24-h ABPM diastolic BP and increased systolic and diastolic hypotensive episodes compared to younger counterparts, despite comparable clinic SBP.
  • Further research is warranted to explore the implications of these findings on antihypertensive therapy and patient outcomes.
Abstract

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