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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis:
Cheng Wang1, Zengchun Ye1, Yan Li2
1Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
Insights
The "reverse dipping" blood pressure pattern indicates a higher risk of mortality and adverse cardiovascular and renal events in chronic kidney disease (CKD) patients. This finding is independent of 24-hour systolic blood pressure levels.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- The prognostic significance of the
- reverse dipping
- blood pressure (BP) pattern in chronic kidney disease (CKD) patients remains unclear.
- Previous studies have focused on the general population or hypertensive individuals.
Purpose of the Study:
- To investigate the prognostic value of the
- reverse dipping
- BP pattern in CKD patients not undergoing dialysis.
Main Methods:
- Prospective monitoring of BP and health outcomes in 588 CKD patients.
- Analysis of time to all-cause mortality, cardiovascular mortality, renal events, and cardiovascular events.
- Multivariate-adjusted Cox regression analyses were employed.
Main Results:
- Prevalence rates were 34.69% for dippers, 43.54% for non-dippers, and 18.03% for reverse dippers.
- Reverse dippers exhibited a higher incidence of total mortality, cardiovascular mortality, renal events, and cardiovascular events compared to dippers (P < 0.025).
- Reverse dipping was independently associated with increased risks of total mortality (HR, 5.08), cardiovascular mortality (HR, 4.17), renal events (HR, 3.00), and cardiovascular events (HR, 4.12).
Conclusions:
- The
- reverse dipping
- BP pattern holds independent prognostic value in CKD patients not on dialysis.
- This pattern predicts adverse outcomes irrespective of 24-hour systolic BP levels.
- Identifying reverse dippers may aid in risk stratification and management of CKD patients.
Abstract:
The "reverse dipping" blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a "dipper", "non-dipper" and "reverse dippers" was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis.
