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Published on: August 9, 2019
Evaluation of self-monitoring of blood pressure in the PERHIT study and the impact on glomerular function
Mikael Ekholm1,2, Ulrika Andersson3, Peter M Nilsson4
1Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
Insights
Self-monitoring blood pressure (BP) systems may be associated with a decline in estimated glomerular filtration rate (eGFR) in hypertensive patients. This finding highlights the need for careful monitoring of kidney function during intensive BP management.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Intensive blood pressure (BP) control reduces cardiovascular risk in chronic kidney disease (CKD) patients, but its effect on CKD progression is unclear.
- Self-monitoring BP systems offer a potential tool for managing hypertension in CKD populations.
Purpose of the Study:
- To investigate the relationship between a self-monitoring BP system and glomerular function in hypertensive individuals.
- To explore the interplay between BP control and estimated glomerular filtration rate (eGFR) in the context of CKD.
Main Methods:
- A post-hoc analysis of 949 hypertensive participants was conducted.
- Participants were randomized into an intervention group (BP monitor and mobile app) or a control group.
- BP was monitored daily by the intervention group for eight weeks, with follow-ups at 12 months.
Main Results:
- The intervention group showed significant decreases in BP, systolic BP (SBP), pulse pressure (PP), and mean arterial blood pressure (MAP).
- A significant association was observed between decreased BP components and a decline in eGFR within the intervention group.
- eGFR significantly decreased in the intervention group, while the control group showed a non-significant trend.
Conclusions:
- A decrease in all BP components was associated with eGFR decline in the intervention group, but not in controls.
- Self-monitoring BP systems may influence glomerular function, necessitating careful monitoring of kidney function.
Background:
Although intensive blood pressure (BP) control has not been shown to slow the progression of chronic kidney disease (CKD), intensive BP control has been shown to reduce the risk for adverse cardiovascular outcomes in the CKD population. The aim of this post-hoc study was to study the interplay between a self-monitoring BP system and glomerular function.
Methods:
In all, 949 participants with hypertension underwent visits at baseline, after eight weeks and 12 months. Half of the participants received a BP monitor and installed a program on their mobile phone. During eight weeks, they measured daily and reported their BP values.
Results:
Within the intervention group, BP and systolic BP (SBP) decreased from baseline to eight weeks and 12 months (p < .001). Pulse pressure (PP) and mean arterial blood pressure (MAP) decreased from baseline to eight weeks (p = .021 and p = .004) vs 12 months (p = .035 and p = .008). Within the control group, a decrease was observed from baseline to 12 months for SBP, diastolic BP (DBP) and PP (p = .025, p = .023 and p = .036). In the intervention group, we observed an association between a decrease in SBP, DBP, PP and MAP and a decrease in eGFR (estimated glomerular filtration rate), (p < .001, p < .001, p = .013 and p < .001). In the control group, similar results were observed for PP only (p = .027). Within the intervention group, eGFR decreased (p < .001) but within the control group, the decrease was non-significant (p = .051).
Conclusion:
We observed an association between a decrease in all BP components and eGFR decline within the normal range in the intervention group but not in the controls.
Trial Registration:
The study was registered with ClinicalTrials.gov [NCT03554382].
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