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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
The Prognostic Role of Automated Office Blood Pressure Measurement in Hypertensive Patients with Chronic Kidney
Konstantinos Psounis1, Emmanuel Andreadis2, Theodora Oikonomaki3
1Department of Hemodialysis, Athens Medical Group, Dafni Clinic, 17237 Athens, Greece.
Insights
Automated office blood pressure (AOBP) effectively predicts cardiovascular and kidney disease progression in patients with chronic kidney disease (CKD). This reliable method can be used in clinical settings for hypertension management.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Hypertension and chronic kidney disease (CKD) stage 3-5 increase cardiovascular (CV) and renal risks.
- Accurate blood pressure (BP) monitoring is crucial for risk stratification in CKD patients.
Purpose of the Study:
- To assess the prognostic capability of automated office blood pressure (AOBP) in predicting adverse outcomes in non-dialysis CKD patients.
- To compare AOBP with traditional office blood pressure (OBP) and ambulatory blood pressure monitoring (ABPM).
Main Methods:
- 140 patients with hypertension and CKD (stage 3-5, not on dialysis) were enrolled.
- BP was measured using OBP, AOBP, and ABPM at baseline.
- Patients were followed for a median of 3.4 years for composite outcomes including CV events or kidney disease progression.
Main Results:
- AOBP measurements were significantly lower than OBP.
- Both systolic and diastolic AOBP were independently predictive of the primary composite outcome (CV events or kidney disease progression) after adjusting for confounders.
- Hazard ratios indicated increased risk with higher AOBP readings.
Conclusions:
- AOBP is a reliable and prognostic tool for assessing cardiovascular and kidney disease progression risk in hypertensive CKD patients.
- AOBP can be effectively utilized in the office setting for improved patient management and risk stratification.
Background:
The aim of this study was to evaluate the prognostic value of automated office blood pressure (AOBP) measurement in patients with hypertension and chronic kidney disease (CKD) stage 3-5 not on dialysis.
Methods:
At baseline, 140 patients were recruited, and blood pressure (BP) measurements with 3 different methods, namely, office blood pressure (OBP), AOBP, and ambulatory blood pressure measurement (ABPM), were recorded. All patients were prospectively followed for a median period of 3.4 years. The primary outcome of this study was a composite outcome of cardiovascular (CV) events (both fatal and nonfatal) or a doubling of serum creatine or progression to end-stage kidney disease (ESKD), whichever occurred first.
Results:
At baseline, the median age of patients was 65.2 years; 36.4% had diabetes; 21.4% had a history of CV disease; the mean of estimated glomerular filtration rate (eGFR) was 33 mL/min/1.73 m2; and the means of OBP, AOBP, and daytime ABPM were 151/84 mm Hg, 134/77 mm Hg, and 132/77 mm Hg, respectively. During the follow-up, 18 patients had a CV event, and 37 patients had a renal event. In the univariate cox regression analysis, systolic AOBP was found to be predictive of the primary outcome (HR per 1 mm Hg increase in BP, 1.019, 95% CI 1.003-1.035), and after adjustment for eGFR, smoking status, diabetes, and a history of CV disease and systolic and diastolic AOBP were also found to be predictive of the primary outcome (HR per 1 mm Hg increase in BP, 1.017, 95% CI 1.002-1.032 and 1.033, 95% CI 1.009-1.058, respectively).
Conclusions:
In patients with CKD, AOBP appears to be prognostic of CV risk or risk for kidney disease progression and could, therefore, be considered a reliable means for recording BP in the office setting.
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