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Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT

Jeff Whittle1, Amy I Lynch2, Rikki M Tanner2

  • 1Primary Care Division, Clement J. Zablocki Veterans Affairs Medical Center, Milwaukee, Wisconsin; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; jeffrey.whittle@va.gov.

Clinical Journal of the American Society of Nephrology : CJASN
|February 26, 2016
PubMed

Insights

Increased blood pressure variability is linked to higher kidney disease risk. This study found higher visit-to-visit blood pressure variability independently predicts worse renal outcomes.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Trials

Background:

  • Visit-to-visit variability in blood pressure (BP) is a known risk factor for cardiovascular disease.
  • Understanding its impact on renal outcomes is crucial for patient management.

Purpose of the Study:

  • To investigate the association between visit-to-visit BP variability and the risk of renal outcomes.
  • To analyze this association in a large cohort from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Main Methods:

  • Utilized data from 21,245 participants in the ALLHAT trial.
  • Measured mean BP and visit-to-visit BP variability (SD) over 5-7 visits.
  • Defined composite renal outcome as incident end-stage renal disease (ESRD) or ≥50% eGFR decline.

Main Results:

  • Higher quintiles of systolic BP variability (SD) were associated with increased risk of the composite renal endpoint (P trend =0.004).
  • Hazard ratios increased progressively with higher SD of systolic BP, with the highest quintile showing a 2.05 HR.
  • Similar associations were observed for ESRD and eGFR decline analyzed separately, and for diastolic BP variability.

Conclusions:

  • Elevated visit-to-visit BP variability is an independent predictor of adverse renal outcomes.
  • These findings highlight the importance of BP stability in preventing kidney disease progression.
Abstract

Keywords:
antihypertensive agentsblood pressureblood pressure variabilitycardiovascular diseasesclinical trialfollow-up studiesglomerular filtration ratehypertensionkidney failure, chronicrandom allocation

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