Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT. Clin J Am Soc Nephrol 2016 Mar 07;11(3):471-80
Date
02/26/2016Pubmed ID
26912544Pubmed Central ID
PMC4791814DOI
10.2215/CJN.04660415Scopus ID
2-s2.0-84960108792 (requires institutional sign-in at Scopus site) 45 CitationsAbstract
BACKGROUND AND OBJECTIVES: Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril. The composite outcome included incident ESRD after assessment of SD of systolic BP or ≥50% decline in eGFR between 24 months and 48 or 72 months after randomization. We repeated the analyses using average real variability and peak value of systolic BP and for visit-to-visit variability of diastolic BP.
RESULTS: Over a mean follow-up of 3.5 years, 297 outcomes occurred. After multivariable adjustment, including baseline eGFR and mean systolic BP, the hazard ratios for the composite end point were 1.29 (95% confidence interval [95% CI], 0.75 to 2.22), 1.76 (95% CI, 1.06 to 2.91), 1.46 (95% CI, 0.88 to 2.45), and 2.05 (95% CI, 1.25 to 3.36) for the second through fifth (SD of systolic BP =6.63-8.82, 8.83-11.14, 11.15-14.56, and >14.56 mmHg, respectively) versus the first (SD of systolic BP <6.63 mmHg) quintile of SD of systolic BP, respectively (P trend =0.004). The association was similar when ESRD and a 50% decline in eGFR were analyzed separately, for other measures of visit-to-visit variability of systolic BP, and for visit-to-visit variability of diastolic BP.
CONCLUSIONS: Higher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.
Author List
Whittle J, Lynch AI, Tanner RM, Simpson LM, Davis BR, Rahman M, Whelton PK, Oparil S, Muntner PAuthor
Jeffrey Whittle MD Professor in the Medicine department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AgedAmlodipine
Antihyperkalemic Agents
Blood Pressure
Blood Pressure Determination
Chlorthalidone
Disease Progression
Female
Glomerular Filtration Rate
Humans
Hypertension
Kidney
Kidney Failure, Chronic
Lisinopril
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Proportional Hazards Models
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic
Risk Factors
Time Factors
Treatment Outcome