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Updated: May 13, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Blood Pressure Variability in Older Patients with Chronic Kidney Disease
Davi Wei Ming Wang1, Bruna Cristine D Rodrigues2, Maria Eugenia Canziani3
1Division of Geriatric, Department of Medicine, Hospital das Clinicas HCFMUSP, São Paulo, Brazil.
Insights
Increased blood pressure variability (BPV) is linked to worse kidney function in older adults with chronic kidney disease (CKD). Both short-term and long-term BPV measurements showed similar results, suggesting their utility in clinical practice.
Area of Science:
- Nephrology
- Cardiology
- Geriatrics
Background:
- Elevated blood pressure variability (BPV) is a known cardiovascular risk factor in the general population.
- Its significance in patients with chronic kidney disease (CKD) remains under-explored.
- This study focuses on BPV in elderly CKD patients.
Purpose of the Study:
- To investigate blood pressure variability (BPV) parameters in a large cohort of elderly patients diagnosed with chronic kidney disease (CKD).
- To assess the relationship between BPV and kidney function in this population.
Main Methods:
- Retrospective cohort study of 1,063 patients aged 75+ years with an estimated glomerular filtration rate (eGFR) ≤60 mL/min.
- Collected automated systolic and diastolic blood pressure (BP) measurements (short-term and long-term).
- Calculated standard deviation (SD), coefficient of variation, and variability independent of the mean (VIM) for BPV.
Main Results:
- Higher systolic BPV (SD and VIM) correlated with older age, fewer males, and higher pulse pressure (>40 mm Hg).
- Higher diastolic BPV (SD and VIM) was associated with lower BMI, lower eGFR, and higher pulse pressure.
- Bland-Altman analysis indicated comparable findings between short-term and long-term BPV measurements.
Conclusions:
- Increased blood pressure variability (BPV) is associated with reduced kidney function in older adults with chronic kidney disease (CKD).
- Short-term and long-term BPV measurements yield similar results.
- Further research is necessary to validate these findings and elucidate underlying mechanisms.
Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
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