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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease
Mahboob Rahman1, Jesse Yenchih Hsu, Niraj Desai
1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material .
Insights
Both central and brachial blood pressure measurements predict cardiovascular disease risk in chronic kidney disease (CKD) patients. However, central BP measurement does not offer improved prediction over standard brachial BP measurements for CKD complications.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Chronic kidney disease (CKD) is associated with increased cardiovascular risk.
- Central blood pressure (BP) offers noninvasive aortic BP measurement.
- Understanding the predictive value of central vs. brachial BP in CKD is crucial.
Purpose of the Study:
- To assess the association of central and brachial BP with cardiovascular outcomes and mortality in CKD patients.
- To determine if central BP measurement improves cardiovascular risk prediction in CKD compared to brachial BP.
Main Methods:
- Prospective, longitudinal study (Chronic Renal Insufficiency Cohort) with 2875 participants.
- Central BP measured using the SphygmoCorPVx System.
- Cox proportional hazards models analyzed cardiovascular outcomes and mortality.
Main Results:
- Elevated brachial systolic BP (≥138 mm Hg) was linked to higher cardiovascular outcome risk (HR, 1.59).
- Elevated central systolic BP was also associated with increased cardiovascular outcome risk (HR, 1.69).
- Neither central nor brachial BP significantly predicted all-cause mortality.
Conclusions:
- Both brachial and central BP are associated with cardiovascular disease risk in CKD patients.
- Central BP measurement does not enhance cardiovascular disease outcome or mortality prediction beyond brachial BP in this population.
Background And Objectives:
Central BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk.
Design, Setting, Participants, & Measurements:
In a prospective, longitudinal study (the Chronic Renal Insufficiency Cohort), central BP was measured in participants with CKD using the SphygmoCorPVx System. Cox proportional hazards models were used for analyses.
Results:
Mean age of the participants (n=2875) was 60 years old. After a median follow-up of 5.5 years, participants in the highest quartile of brachial systolic BP (≥138 mm Hg) were at higher risk for the composite cardiovascular outcome (hazard ratio, 1.59; 95% confidence interval, 1.17 to 2.17; c statistic, 0.76) but not all-cause mortality (hazard ratio, 1.28; 95% confidence interval, 0.90 to 1.80) compared with those in the lowest quartile. Participants in the highest quartile of central systolic BP were also at higher risk for the composite cardiovascular outcome (hazard ratio, 1.69; 95% confidence interval, 1.24 to 2.31; c statistic, 0.76) compared with participants in the lowest quartile.
Conclusions:
We show that elevated brachial and central BP measurements are both associated with higher risk of cardiovascular disease outcomes in patients with CKD. Measurement of central BP does not improve the ability to predict cardiovascular disease outcomes or mortality in patients with CKD compared with brachial BP measurement.
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