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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Circadian blood pressure patterns and blood pressure control in patients with chronic kidney disease
Nicola Di Daniele1, Danilo Alunni Fegatelli2, Valentina Rovella1
1Hypertension and Nephrology Unit, Department of Medicine, Policinico Tor Vergata, Universita'di Roma Tor Vergata, Rome, Italy.
Insights
Chronic kidney disease (CKD) did not affect blood pressure (BP) control rates in hypertensive patients. However, CKD patients showed a higher prevalence of abnormal BP patterns, including reverse dipping and daytime hypotension.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Hypertension is a primary risk factor for chronic kidney disease (CKD) progression.
- Suboptimal blood pressure (BP) control is linked to worsening CKD.
- Understanding BP control and circadian patterns in CKD patients is crucial.
Purpose of the Study:
- To assess the impact of CKD on achieving BP control in older adults.
- To analyze the circadian BP profile in hypertensive patients with and without CKD.
Main Methods:
- Observational study of 547 hypertension clinic patients (224 with CKD).
- 24-hour ambulatory BP monitoring used for BP control and circadian pattern evaluation.
- Circadian BP variability assessed via SD, high readings, hypotension, and dipping status.
Main Results:
- BP control rates were similar (approx. 31%) in patients with and without CKD.
- CKD was not a significant determinant of adequate BP control.
- CKD patients had double the prevalence of reverse dipping (systolic BP night peak) and daytime hypotension.
Conclusions:
- Circadian BP patterns in hypertensive CKD patients offer insights beyond BP targets for CKD progression and cognitive decline risk.
- Personalized antihypertensive treatment strategies may benefit from considering these circadian BP profiles.
Background And Aims:
Hypertension is a major risk factor for chronic kidney disease (CKD), and CKD progression is associated with suboptimal blood pressure (BP) control. Here we evaluate the impact of CKD on the attainment of BP control and the circadian BP profile in older subjects.
Methods:
In this observational study, we studied 547 patients referred to the hypertension clinic, of whom 224 (40.9%) had CKD. Blood pressure (BP) control and circadian BP patterns were evaluated by 24-hour ambulatory BP monitoring. Circadian BP variability was measured as the within-subject SD of BP, the percentage of measurements exceeding normal values, hypotension, and dipping status.
Results:
The attainment of adequate BP control was similar in subjects with or without CKD (around 31%). Logistic regression analysis indicated that CKD was not a determinant of adequate BP control (OR 1.004; 95% CI 0.989-1.019; p = 0.58). Patients with CKD presented as twice as higher prevalence of reverse dipper (night-time peak) for systolic BP and episodes of hypotension during daytime, independently of BP control.
Conclusions:
Knowledge of the circadian pattern of BP in hypertensive subjects with CKD could inform better than attainment of BP target about risky condition for CKD progression and cognitive decline and allow a more personalized antihypertensive treatment.
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