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Associations Between Arterial Stiffness Indices and Chronic Kidney Disease Categories in Essential Hypertensive

Hiroshi Kusunoki1,2, Yoshio Iwashima2,3, Yuhei Kawano4

  • 1Department of General Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.

American Journal of Hypertension
|October 8, 2020
PubMed

Insights

Arterial stiffness, including aortic pulse wave velocity and renal resistive index, is linked to higher chronic kidney disease (CKD) risk in hypertensive patients. Circadian variations in blood pressure and stiffness may contribute to CKD progression.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Hypertension Research

Background:

  • Essential hypertension is a significant risk factor for chronic kidney disease (CKD).
  • Arterial stiffness is an independent predictor of cardiovascular events and mortality.
  • Early detection of CKD risk in hypertensive patients is crucial for timely intervention.

Purpose of the Study:

  • To investigate the association between arterial stiffness indices and asymptomatic chronic kidney disease (CKD) risk categories in hypertensive patients.
  • To identify specific arterial stiffness parameters that predict higher CKD risk.
  • To explore the role of circadian hemodynamic variations in the relationship between arterial stiffness and CKD.

Main Methods:

  • 184 essential hypertensive patients were assessed for arterial stiffness using 24-hour ambulatory blood pressure monitoring, pulse wave velocity (PWV) measurements (aortic and brachial-ankle), and renal resistive index (RI) via ultrasonography.
  • Chronic kidney disease (CKD) risk was categorized using Kidney Disease Improving Global Outcomes (KDIGO) criteria, based on estimated glomerular filtration rate and albuminuria.
  • Multivariate logistic regression and multivariate regression models were employed to analyze the associations between arterial stiffness indices, circadian hemodynamics, and CKD risk categories.

Main Results:

  • 24-hour aortic PWV (aPWV), brachial-ankle PWV (baPWV), and RI demonstrated a significant increase with worsening CKD risk categories (P < 0.01).
  • Increased nighttime aortic systolic blood pressure (SBP), PWV, and RI were independently associated with higher CKD stages (ORs ranging from 1.52 to 4.80, P < 0.05).
  • Disturbed day-to-night changes in brachial SBP and aPWV were observed, and these circadian variations were linked to intrarenal hemodynamics.

Conclusions:

  • Hypertensive patients with higher CKD risk exhibit altered circadian hemodynamics, characterized by elevated nighttime aortic SBP and PWV, and impaired intrarenal hemodynamics.
  • Blunted nocturnal blood pressure reduction in these patients may be influenced by disturbed intrarenal hemodynamics and circadian variations in aortic SBP and arterial stiffness.
  • Arterial stiffness indices, particularly those reflecting aortic stiffness and intrarenal hemodynamics, are valuable markers for assessing CKD risk in hypertensive individuals.
Abstract

Keywords:
albuminuriaambulatory blood pressure monitoringarterial stiffnessblood pressurecentral blood pressurehemodynamic characteristicshypertensionpulse wave analysisrenal resistive index

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