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The association of blood pressure variability with adverse outcomes in a primary care chronic kidney disease cohort

journal contribution
posted on 30.06.2021, 15:15 by Susil Pallikadavath, Lucy Chambers, David Shepherd, Mahak Sukhnani, James F Medcalf, Laura J Gray, Nigel J Brunskill, Rupert W Major
Background:
Hypertension is common in individuals with chronic kidney disease and both conditions are associated with adverse outcomes including cardiovascular morbidity. Therefore, it is clinically important to identify methods of risk prediction in individuals with chronic kidney disease. Blood pressure variability has recently emerged as a predictor of cardiovascular events and mortality in the general population, with growing evidence indicating that it may play a similar role in individuals with chronic kidney disease. However, there have been no large studies assessing blood pressure variability in individuals with chronic kidney disease in primary care, where the majority of these patients are managed.

Method:
Using a retrospective observational study design, we analyzed routinely collected blood pressure readings from 16 999 individuals in The Leicester and County Chronic Kidney Disease cohort. Standard deviation, coefficient of variation and average real variability of SBP were used to calculate blood pressure variability.

Results:
During a median follow-up of 5.0 (IQR 3.3--5.0) years, 2053 (12.1%) patients had cardiovascular events, death occurred in 5021 (29.6%) individuals and 156 (0.9%) individuals had endstage kidney disease events. In adjusted models, standard deviation and coefficient of variation were associated with cardiovascular events, all-cause mortality and endstage kidney disease. Average real variability was associated with all-cause mortality and cardiovascular events, but not endstage kidney disease.

Conclusion:
Blood pressure variability may be an accessible, routinely collected, noninvasive measure for stratifying the risk of adverse events in individuals with chronic kidney disease in a primary care setting.

History

Author affiliation

Department of Health Sciences, University of Leicester

Version

AM (Accepted Manuscript)

Published in

Journal of Hypertension

Publisher

Lippincott, Williams & Wilkins

issn

0263-6352

eissn

1473-5598

Acceptance date

16/04/2021

Copyright date

2021

Available date

14/05/2022

Spatial coverage

England

Language

eng