Blood Pressure Variability in Older Patients with Chronic Kidney Disease

An increased blood pressure variability (BPV) is associated with a high risk of cardiovascular events in the general population. This concept was scarcely tested in patients with chronic kidney disease (CKD). We investigated the behavior of BPV parameters in a large cohort of older patients with CKD.

This retrospective cohort study included patients ≥75 years old with eGFR ≤60 mL/min. Three systolic and diastolic consecutive blood pressure (BP) measurements were obtained automatically per visit (short term - 3 consecutive measurements) and across visits (long term - across visits). We calculated (1) standard deviation (SD); (2) coefficient of variation (SD divided by the BP average); and (3) variability independent of the mean (VIM). For each BPV parameter, patients were divided into quartiles.

We included 1,063 patients (17,363 measurements). For short BPV, the higher systolic BPV (SD and VIM) was associated with older age, a lower proportion of males, and a higher proportion of patients with pulse pressure (PP) >40 mm Hg. Higher diastolic BPV (SD and VIM) was associated with lower body mass index, lower eGFR, and a higher proportion of PP >40 mm Hg (for SD). Bland-Altman plots revealed comparable results between short- and long-term BPV.

A higher BPV was associated with reduced renal function in older patients with CKD. Our study also suggests that short- and long-term BPV can be used with similar results. Further studies are needed to confirm the association between BPV and outcomes and understand the physiological mechanisms underlying this correlation.