Diastolic Blood Pressure Variability Predicts Cardiovascular Outcomes in CKD, Especially in Advanced Stages

Area of Science:

• Cardiology
• Nephrology
• Hypertension Research

Background:

• Chronic kidney disease (CKD) significantly elevates cardiovascular event risk.
• The prognostic role of diastolic blood pressure variability (DBPV) in CKD remains less understood compared to systolic blood pressure variability (SBPV).

Purpose of the Study:

• To evaluate the independent prognostic value of DBPV in predicting adverse cardiovascular outcomes in CKD patients.
• To compare the predictive capability of DBPV against SBPV in this population.

Main Methods:

• A retrospective cohort study included 1,245 adult CKD patients (stages G3a-G5).
• 24-hour ambulatory blood pressure monitoring assessed DBPV parameters (e.g., 24-hour DBP standard deviation).
• Cox proportional hazards models analyzed associations with all-cause mortality, cardiovascular death, and heart failure hospitalization, adjusting for confounders.

Main Results:

• Higher 24-hour DBP standard deviation was independently associated with increased all-cause mortality (HR 1.08) and cardiovascular death (HR 1.11).
• A nondipping DBP pattern correlated with higher heart failure hospitalization risk (HR 1.42).
• DBPV demonstrated incremental predictive value over SBPV for cardiovascular death (IDI 0.023, P=0.004), particularly in advanced CKD stages.

Conclusions:

• DBPV is an independent predictor of adverse cardiovascular outcomes in CKD patients.
• The prognostic significance of DBPV is more pronounced in advanced stages of CKD (G4-5).
• DBPV offers added value to SBPV for risk stratification in CKD patients.