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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Association Between Systolic Blood Pressure Variability and Major Adverse Cardiovascular Events in Korean Patients
Cheol Ho Park1, Hyung Woo Kim1, Young Su Joo1
1Department of Internal Medicine College of MedicineInstitute of Kidney Disease ResearchYonsei University Seoul Republic of Korea.
Insights
Higher visit-to-visit systolic blood pressure (SBP) variability increases the risk of major adverse cardiovascular events (MACE) in chronic kidney disease patients. This finding highlights SBP variability as a crucial predictor for cardiovascular outcomes in this population.
Area of Science:
- Cardiology
- Nephrology
- Clinical Research
Background:
- Systolic blood pressure (SBP) variability is a potential risk factor for cardiovascular events.
- Its predictive value for major adverse cardiovascular events (MACE) in patients with chronic kidney disease (CKD) remains uncertain.
Purpose of the Study:
- To investigate the association between visit-to-visit SBP variability and the incidence of MACE in a cohort of patients with CKD.
Main Methods:
- The Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease (KNOW-CKD) enrolled 1575 participants.
- Visit-to-visit SBP variability was assessed using standard deviation (SD) during the first year.
- Participants were stratified into tertiles of SBP variability, and MACE (composite of nonfatal MI, unstable angina, revascularization, nonfatal stroke, HF hospitalization, or cardiac death) was recorded over a median follow-up of 4.2 years.
Main Results:
- A total of 64 MACE occurred during 6748 patient-years of follow-up.
- Compared to the lowest tertile of SBP variability, the middle and highest tertiles showed increased MACE risk (HR 1.64, 2.23 respectively).
- Each 5 mmHg increase in SBP variability (SD) was associated with a 21% increased MACE risk (HR 1.21).
- Results were consistent across sensitivity analyses using different variability metrics (coefficient of variation, variation independent of the mean).
Conclusions:
- Elevated visit-to-visit SBP variability is significantly associated with an increased risk of MACE in patients with chronic kidney disease.
- SBP variability serves as an important independent predictor of adverse cardiovascular outcomes in CKD patients.
Abstract:
Background Whether visit-to-visit systolic blood pressure (SBP) variability can predict major adverse cardiovascular events (MACE) in patients with chronic kidney disease is unclear. Methods and Results We investigated the relationship between SDs of visit-to-visit SBP variability during the first year of enrollment and MACE among 1575 participants from KNOW-CKD (Korean Cohort Study for Outcome in Patients With Chronic Kidney Disease). Participants were categorized into 3 groups according to tertiles of visit-to-visit SBP variability (SD). The study end point was MACE, defined as a composite of nonfatal myocardial infarction, unstable angina, revascularization, nonfatal stroke, hospitalization for heart failure, or cardiac death. During 6748 patient-years of follow-up (median, 4.2 years), MACE occurred in 64 participants (4.1%). Compared with the lowest tertile of visit-to-visit SBP variability (SD), the hazard ratios (HRs) for the middle and the highest tertile were 1.64 (95% CI, 0.80-3.36) and 2.23 (95% CI, 1.12-4.44), respectively, in a multivariable cause-specific hazard model. In addition, the HR associated with each 5-mm Hg increase in visit-to-visit SBP variability (SD) was 1.21 (95% CI, 1.01-1.45). This association was consistent in sensitivity analyses with 2 additional definitions of SBP variability determined by the coefficient of variation and variation independent of the mean. The corresponding HRs for the middle and highest tertiles were 2.11 (95% CI, 1.03-4.35) and 2.28 (95% CI, 1.12-4.63), respectively, in the analysis with the coefficient of variation and 1.76 (95% CI, 0.87-3.57) and 2.04 (95% CI, 1.03-4.03), respectively, with the variation independent of the mean. Conclusions Higher visit-to-visit SBP variability is associated with an increased risk of MACE in patients with chronic kidney disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01630486.
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