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Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric
Christine B Sethna1, Kevin E C Meyers2, Laura H Mariani2
1From the Cohen Children's Medical Center of New York (C.B.S.); The Children's Hospital of Philadelphia, PA (K.E.C.M.); University of Michigan, Ann Arbor (L.H.M., M.K.); Arbor Research, MI (L.H.M.); Johns Hopkins School of Medicine, Baltimore, MD (K.J.P., T.M.B.); Temple University, Philadelphia, PA (C.A.G.); University of North Carolina, Chapel Hill (K.L.G.); and Children's Mercy Hospital, Kansas City, MO (T.S.). csethna@northwell.edu.
Insights
Hypertension and blood pressure variability are common in primary proteinuric glomerulopathies. Both conditions are linked to worse clinical outcomes, including lower remission rates and higher risks of kidney failure in adults and children.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Research
Background:
- Hypertension and blood pressure variability (BPV) are not well characterized in primary proteinuric glomerulopathies.
- Understanding these factors is crucial for predicting disease progression and outcomes in affected patients.
Purpose of the Study:
- To describe the prevalence of hypertension and BPV in adults and children with primary proteinuric glomerulopathies.
- To investigate the association of hypertension and BPV with clinical outcomes, including remission and composite endpoints.
Main Methods:
- Analysis of data from 433 participants in the NEPTUNE study.
- Hypertensive status defined by history or baseline BP measurements.
- BPV measured using standard deviation (SD) and average real variability over the first year.
Main Results:
- A high prevalence of hypertension was observed: 64.8% in adults and 46.9% in children.
- In adults, hypertension was associated with a lower chance of complete remission and a higher risk of the composite endpoint (ESRD or >40% eGFR decline).
- Increased BPV (systolic and diastolic) independently predicted a greater hazard of the composite endpoint in both adults and children, and poorer remission in children.
Conclusions:
- Hypertensive status and elevated blood pressure variability are common in primary proteinuric glomerulopathies.
- Both hypertension and increased BPV are associated with adverse clinical outcomes, highlighting their importance in disease management.
- Findings underscore the need for monitoring and managing blood pressure in these patient populations.
Abstract:
Hypertension and blood pressure variability (BPV; SD and average real variability) in primary proteinuric glomerulopathies are not well described. Data were from 433 participants in the NEPTUNE (Nephrotic Syndrome Study Network). Hypertensive BP status was defined as previous history of hypertension or BP ≥140/90 mm Hg for adults/≥95th percentile for children at baseline. BPV was measured in participants with ≥3 visits in the first year. Two-hundred ninety-six adults (43 years [interquartile range, 32-57.8 years], 61.5% male) and 147 children (11 years [interquartile range, 5-14 years], 57.8% male) were evaluated. At baseline, 64.8% of adults and 46.9% of children were hypertensive. Histological diagnosis was associated with hypertensive status in adults (P=0.036). In adults, hypertensive status was associated with lower hazard of complete remission (hazard ratio, 0.36; 95% confidence interval, 0.19-0.68) and greater hazard of achieving the composite end point (end-stage renal disease or estimated glomerular filtration rate decline >40%; hazard ratio, 4.1; 95% confidence interval, 1.4-12). Greater systolic and diastolic SD and average real variability were also associated with greater hazard of reaching the composite end point in adults (all P<0.01). In children, greater BPV was an independent predictor of composite end point (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability; all P<0.05). Hypertensive status was common among adults and children enrolled in NEPTUNE. Differences in hypertensive status prevalence, BPV, and treatment were found by age and histological diagnosis. In addition, hypertensive status and greater BPV were associated with poorer clinical outcomes.
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