Mortality according to ambulatory blood pressure in hypertensive patients with normal or impaired kidney function

Area of Science:

• Nephrology
• Cardiology
• Hypertension Research

Background:

• Hypertension is a major risk factor for mortality in chronic kidney disease (CKD).
• Understanding the relationship between blood pressure (BP) and mortality is crucial for managing CKD patients.
• Ambulatory blood pressure monitoring (ABPM) offers a more comprehensive assessment of BP compared to clinic measurements.

Purpose of the Study:

• To evaluate the association of ambulatory BP with total and cardiovascular mortality in hypertensive patients with varying kidney function.
• To compare the predictive value of ambulatory BP versus clinic BP for mortality in CKD patients.

Main Methods:

• Utilized data from the Spanish ABPM Registry, including 34,006 hypertensive patients with estimated glomerular filtration rate (eGFR) data.
• Employed fully-adjusted Cox models to assess associations between BP measurements and mortality outcomes.
• Analyzed mortality risk across subgroups based on normal or reduced eGFR (<60 mL/min/1.73 m²).

Main Results:

• Elevated 24-hour, daytime, and nighttime systolic BP were associated with increased total mortality.
• Clinic systolic BP showed a U-shaped association with mortality.
• Lower ambulatory systolic BP (<120 mmHg) was linked to reduced mortality risk specifically in patients with impaired kidney function.

Conclusions:

• Ambulatory BP monitoring is more informative than clinic BP for predicting mortality risk in patients with impaired kidney function.
• Lowering ambulatory BP levels is associated with reduced mortality in CKD patients.
• These findings highlight the importance of ABPM for risk stratification and management in hypertensive CKD populations.