Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease

Rajiv Agarwal, M. J. Andersen

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

Ambulatory systolic blood pressure (BP) correlates better with risk factors for progression of chronic kidney disease (CKD) compared to clinic measured BP, but its role in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. In a cohort study of 217 Veterans with CKD BP was measured by ambulatory monitoring and in the clinic. Twenty-four hour ambulatory BP was 133.5 ± 16.6/73.1 ± 11.1 mm Hg and clinic BP was 155.2 ± 25.6/84.7 ± 14.2 mm Hg. The composite renal end point of ESRD or death over a median follow-up of 3.5 years occurred in 75 patients (34.5%), death occurred in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). Thirty-nine patients died before reaching ESRD. One standard deviation (s.d.) increase in systolic BP increased the risk of composite outcome to 1.69 (95% confidence interval (CI) 1.32-2.17) for standard clinic measurement and to 1.88 (95% CI 1.48-2.39) for 24 h ambulatory BP recording. One s.d. increase in 24 h ambulatory systolic BP increased the risk of ESRD to 3.04 (95% CI 2.13-4.35) and to 2.20 (95% CI 1.43-3.39) when adjusted for standard clinic systolic BP. Non-dipping was associated with increased risk of total mortality and composite end point. In patients with CKD, BPs obtained by ambulatory monitoring are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic ambulatory BP and nondipping are independent predictors for ESRD after adjusting for clinic BP. However, adjustment for other risk factors for CKD progression removes the independent prognostic value of ambulatory BP.

Original languageEnglish
Pages (from-to)1175-1180
Number of pages6
JournalKidney International
Volume69
Issue number7
DOIs
StatePublished - Apr 2006

Fingerprint

Chronic Renal Insufficiency
Blood Pressure
Chronic Kidney Failure
Confidence Intervals
Ambulatory Monitoring
Veterans
Disease Progression
Cohort Studies

Keywords

  • Ambulatory blood pressure
  • Chronic kidney disease
  • Clinic blood pressure
  • End-stage renal disease

ASJC Scopus subject areas

  • Nephrology

Cite this

Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease. / Agarwal, Rajiv; Andersen, M. J.

In: Kidney International, Vol. 69, No. 7, 04.2006, p. 1175-1180.

Research output: Contribution to journalArticle

@article{3e02d5cb338a4e96b21c1fe092a0f0bb,
title = "Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease",
abstract = "Ambulatory systolic blood pressure (BP) correlates better with risk factors for progression of chronic kidney disease (CKD) compared to clinic measured BP, but its role in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. In a cohort study of 217 Veterans with CKD BP was measured by ambulatory monitoring and in the clinic. Twenty-four hour ambulatory BP was 133.5 ± 16.6/73.1 ± 11.1 mm Hg and clinic BP was 155.2 ± 25.6/84.7 ± 14.2 mm Hg. The composite renal end point of ESRD or death over a median follow-up of 3.5 years occurred in 75 patients (34.5{\%}), death occurred in 52 patients (24.0{\%}), and ESRD in 36/178 patients (20.2{\%}). Thirty-nine patients died before reaching ESRD. One standard deviation (s.d.) increase in systolic BP increased the risk of composite outcome to 1.69 (95{\%} confidence interval (CI) 1.32-2.17) for standard clinic measurement and to 1.88 (95{\%} CI 1.48-2.39) for 24 h ambulatory BP recording. One s.d. increase in 24 h ambulatory systolic BP increased the risk of ESRD to 3.04 (95{\%} CI 2.13-4.35) and to 2.20 (95{\%} CI 1.43-3.39) when adjusted for standard clinic systolic BP. Non-dipping was associated with increased risk of total mortality and composite end point. In patients with CKD, BPs obtained by ambulatory monitoring are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic ambulatory BP and nondipping are independent predictors for ESRD after adjusting for clinic BP. However, adjustment for other risk factors for CKD progression removes the independent prognostic value of ambulatory BP.",
keywords = "Ambulatory blood pressure, Chronic kidney disease, Clinic blood pressure, End-stage renal disease",
author = "Rajiv Agarwal and Andersen, {M. J.}",
year = "2006",
month = "4",
doi = "10.1038/sj.ki.5000247",
language = "English",
volume = "69",
pages = "1175--1180",
journal = "Kidney International",
issn = "0085-2538",
publisher = "Nature Publishing Group",
number = "7",

}

TY - JOUR

T1 - Prognostic importance of ambulatory blood pressure recordings in patients with chronic kidney disease

AU - Agarwal, Rajiv

AU - Andersen, M. J.

PY - 2006/4

Y1 - 2006/4

N2 - Ambulatory systolic blood pressure (BP) correlates better with risk factors for progression of chronic kidney disease (CKD) compared to clinic measured BP, but its role in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. In a cohort study of 217 Veterans with CKD BP was measured by ambulatory monitoring and in the clinic. Twenty-four hour ambulatory BP was 133.5 ± 16.6/73.1 ± 11.1 mm Hg and clinic BP was 155.2 ± 25.6/84.7 ± 14.2 mm Hg. The composite renal end point of ESRD or death over a median follow-up of 3.5 years occurred in 75 patients (34.5%), death occurred in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). Thirty-nine patients died before reaching ESRD. One standard deviation (s.d.) increase in systolic BP increased the risk of composite outcome to 1.69 (95% confidence interval (CI) 1.32-2.17) for standard clinic measurement and to 1.88 (95% CI 1.48-2.39) for 24 h ambulatory BP recording. One s.d. increase in 24 h ambulatory systolic BP increased the risk of ESRD to 3.04 (95% CI 2.13-4.35) and to 2.20 (95% CI 1.43-3.39) when adjusted for standard clinic systolic BP. Non-dipping was associated with increased risk of total mortality and composite end point. In patients with CKD, BPs obtained by ambulatory monitoring are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic ambulatory BP and nondipping are independent predictors for ESRD after adjusting for clinic BP. However, adjustment for other risk factors for CKD progression removes the independent prognostic value of ambulatory BP.

AB - Ambulatory systolic blood pressure (BP) correlates better with risk factors for progression of chronic kidney disease (CKD) compared to clinic measured BP, but its role in predicting end-stage renal disease (ESRD) and death in patients with CKD is unknown. In a cohort study of 217 Veterans with CKD BP was measured by ambulatory monitoring and in the clinic. Twenty-four hour ambulatory BP was 133.5 ± 16.6/73.1 ± 11.1 mm Hg and clinic BP was 155.2 ± 25.6/84.7 ± 14.2 mm Hg. The composite renal end point of ESRD or death over a median follow-up of 3.5 years occurred in 75 patients (34.5%), death occurred in 52 patients (24.0%), and ESRD in 36/178 patients (20.2%). Thirty-nine patients died before reaching ESRD. One standard deviation (s.d.) increase in systolic BP increased the risk of composite outcome to 1.69 (95% confidence interval (CI) 1.32-2.17) for standard clinic measurement and to 1.88 (95% CI 1.48-2.39) for 24 h ambulatory BP recording. One s.d. increase in 24 h ambulatory systolic BP increased the risk of ESRD to 3.04 (95% CI 2.13-4.35) and to 2.20 (95% CI 1.43-3.39) when adjusted for standard clinic systolic BP. Non-dipping was associated with increased risk of total mortality and composite end point. In patients with CKD, BPs obtained by ambulatory monitoring are a stronger predictor of ESRD or death compared to BPs obtained in the clinic. Systolic ambulatory BP and nondipping are independent predictors for ESRD after adjusting for clinic BP. However, adjustment for other risk factors for CKD progression removes the independent prognostic value of ambulatory BP.

KW - Ambulatory blood pressure

KW - Chronic kidney disease

KW - Clinic blood pressure

KW - End-stage renal disease

UR - http://www.scopus.com/inward/record.url?scp=33645499898&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33645499898&partnerID=8YFLogxK

U2 - 10.1038/sj.ki.5000247

DO - 10.1038/sj.ki.5000247

M3 - Article

VL - 69

SP - 1175

EP - 1180

JO - Kidney International

JF - Kidney International

SN - 0085-2538

IS - 7

ER -