Dipping Status, Ambulatory Blood Pressure Control, Cardiovascular Disease, and Kidney Disease Progression: A Multicenter Cohort Study of CKD

• DOI: 10.1053/j.ajkd.2022.04.010
• Publication Date: 2022-06-13T07:59:31Z
• Authors: Silvio Borrelli; Carlo Garofalo; Francis B. Gabbai; Paolo Chiodini; Simona Signoriello; Ernesto Paoletti; Maura Ravera; Elisabetta Bussalino; Vincenzo Bellizzi; Maria Elena Liberti; Luca De Nicola; Roberto Minutolo
• Keywords: Male; Blood Pressure; Middle Aged; Blood Pressure Monitoring, Ambulatory; Kidney; Circadian Rhythm; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Cardiovascular Diseases; Risk Factors; Hypertension; Disease Progression; Humans; Female; Prospective Studies; Renal Insufficiency, Chronic; ABPM; Ambulatory blood pressure monitoring; CKD; ESKD; cardiovascular risk; circadian profile; daytime blood pressure; dipping status; hypertension; nighttime blood pressure; nocturnal hypertension; renal risk

Ambulatory blood pressure (BP) monitoring allows concurrent evaluation of BP control and nocturnal dipping status, both related to adverse outcomes. However, few studies have assessed the prognostic role combining information on status achieved ambulatory in patients with chronic kidney disease (CKD).Prospective observational cohort study.906 hypertension CKD attending 1 3 Italian nephrology clinics.Four groups were defined by simultaneously classifying systolic levels as being at goal (daytime SBP <135 nighttime <120 mm Hg) or above goal, presence absence (nighttime daytime ratio <0.9 versus ≥0.9).The composite time initiation maintenance dialysis estimated glomerular filtration rate (eGFR) decline ≥50%, fatal nonfatal cardiovascular events.Multivariable Cox proportional hazards models used estimate risks progression 4 exposure where was reference group.The mean patient age 63.8 years, 61% male, 26.4% had diabetes; eGFR 41.1 ± 20.8 mL/min/1.73 m2. The prevalence each follows: 18.6%; no 20.5%; 11.8%; 49.1%. Among risk events greater (HR, 2.79 [95% CI, 1.64-4.75]) 2.05 1.10-3.84]) dipping. same held true for (HRs 2.40 1.58-3.65] 2.11 1.28-3.48] dipping, respectively). Patients but who did not experience an increased end point 2.06 1.15-3.68]) outcome 1.82 1.17-2.82]).Lack a diverse (all those enrolled White). Residual uncontrolled confounding.Systolic regardless BP, is associated higher among CKD.Among (CKD), improves identification individuals high clinical Those are known developing progression, particularly when their does least 10% night. Whether this also optimal pattern largely unknown. We measured 900 followed them several years. found that, independent level, reductions worsening more frequent events. declines factor CKD. Future needed examine whether treating