open access

Vol 21, No 1 (2017)
ORIGINAL PAPERS
Published online: 2017-03-30
Get Citation

Central blood pressure and nighttime blood pressure in patients with non-diabetic chronic kidney disease

Piotr Kuczera, Katarzyna Kwiecień, Marcin Adamczak, Teresa Bączkowska, Jolanta Gozdowska, Katarzyna Madziarska, Hanna Augustyniak-Bartosik, Beata Czerwieńska, Marian Klinger, Magdalena Durlik, Andrzej Więcek,
DOI: 10.5603/AH.2017.0005
·
Arterial Hypertension 2017;21(1):34-41.

open access

Vol 21, No 1 (2017)
ORIGINAL PAPERS
Published online: 2017-03-30

Abstract

Introduction. Arterial hypertension is a well-known risk factor of both cardiovascular complications and faster progression of chronic kidney disease (CKD). There is growing evidence that central blood pressure (BP) and nighttime BP may have an advantage in predicting the risk of cardiovascular complications and the progression of CKD in comparison with the traditional office BP measurements. The aim of this study was to evaluate the central BP and nighttime BP in non-diabetic CKD patients with no, or only mild proteinuria i.e. autosomal dominant polycystic kidney disease (ADPKD) or IgA nephropathy (IgAN).

Material and methods. Forty patients with CKD stage 3 or 4 were enrolled into the study. In each patient the measurement of peripheral and central BP was conducted, as well as the assessment of pulse wave velocity (PWV) and the 24-hour blood pressure monitoring (ABPM).

Results. Despite the lower office and central BP values in patients with IgAN in comparison to patients with ADPKD, both studied groups did not differ in the mean BP in the 24-hour ABPM. In the entire studied group a significant positive correlation was found between the augmentation pressure and age, as well as between the augmentation index - AIx% and age. Moreover, a significant positive correlation between the decrease of nighttime BP and eGFR was observed. Additionally, a significant positive correlation between PWV and age was found.

Conclusions. 1. Patients with ADPKD and IgAN, despite the differences in office and central BP do not differ in respect of the mean BP in the 24-hour ABPM. 2. In both groups of patients vascular stiffness increases with age and deteriorating kidney function. 3. Lower decrease of nighttime blood pressure is related to the worse kidney function in patients with non-diabetic CKD.

Abstract

Introduction. Arterial hypertension is a well-known risk factor of both cardiovascular complications and faster progression of chronic kidney disease (CKD). There is growing evidence that central blood pressure (BP) and nighttime BP may have an advantage in predicting the risk of cardiovascular complications and the progression of CKD in comparison with the traditional office BP measurements. The aim of this study was to evaluate the central BP and nighttime BP in non-diabetic CKD patients with no, or only mild proteinuria i.e. autosomal dominant polycystic kidney disease (ADPKD) or IgA nephropathy (IgAN).

Material and methods. Forty patients with CKD stage 3 or 4 were enrolled into the study. In each patient the measurement of peripheral and central BP was conducted, as well as the assessment of pulse wave velocity (PWV) and the 24-hour blood pressure monitoring (ABPM).

Results. Despite the lower office and central BP values in patients with IgAN in comparison to patients with ADPKD, both studied groups did not differ in the mean BP in the 24-hour ABPM. In the entire studied group a significant positive correlation was found between the augmentation pressure and age, as well as between the augmentation index - AIx% and age. Moreover, a significant positive correlation between the decrease of nighttime BP and eGFR was observed. Additionally, a significant positive correlation between PWV and age was found.

Conclusions. 1. Patients with ADPKD and IgAN, despite the differences in office and central BP do not differ in respect of the mean BP in the 24-hour ABPM. 2. In both groups of patients vascular stiffness increases with age and deteriorating kidney function. 3. Lower decrease of nighttime blood pressure is related to the worse kidney function in patients with non-diabetic CKD.

Get Citation

Keywords

central blood pressure, nighttime blood pressure decrease, chronic kidney disease

About this article
Title

Central blood pressure and nighttime blood pressure in patients with non-diabetic chronic kidney disease

Journal

Arterial Hypertension

Issue

Vol 21, No 1 (2017)

Pages

34-41

Published online

2017-03-30

DOI

10.5603/AH.2017.0005

Bibliographic record

Arterial Hypertension 2017;21(1):34-41.

Keywords

central blood pressure
nighttime blood pressure decrease
chronic kidney disease

Authors

Piotr Kuczera
Katarzyna Kwiecień
Marcin Adamczak
Teresa Bączkowska
Jolanta Gozdowska
Katarzyna Madziarska
Hanna Augustyniak-Bartosik
Beata Czerwieńska
Marian Klinger
Magdalena Durlik
Andrzej Więcek

References (27)
  1. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet. 2002; 360(9349): 1903–1913.
  2. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ. 2009; 338: b1665.
  3. Williams B, Lacy PS, Thom SM, et al. CAFE Investigators, Anglo-Scandinavian Cardiac Outcomes Trial Investigators, CAFE Steering Committee and Writing Committee. Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation. 2006; 113(9): 1213–1225.
  4. Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation. 2003; 107(22): 2864–2869.
  5. O'Rourke MF. Pulsatile arterial haemodynamics in hypertension. Aust N Z J Med. 1976; 6 suppl 2: 40–48.
  6. McEniery CM, McDonnell B, Munnery M, et al. Anglo-Cardiff Collaborative Trial Investigators. Central pressure: variability and impact of cardiovascular risk factors: the Anglo-Cardiff Collaborative Trial II. Hypertension. 2008; 51(6): 1476–1482.
  7. Trudeau L. Central blood pressure as an index of antihypertensive control: determinants and potential value. Can J Cardiol. 2014; 30(5 Suppl): S23–S28.
  8. Hashimoto J. Central hemodynamics and target organ damage in hypertension. Tohoku J Exp Med. 2014; 233(1): 1–8.
  9. Turin TC, Kita Y, Rumana N, et al. Brachial-ankle pulse wave velocity predicts all-cause mortality in the general population: findings from the Takashima study, Japan. Hypertens Res. 2010; 33(9): 922–925.
  10. Takashima N, Turin TC, Matsui K, et al. The relationship of brachial-ankle pulse wave velocity to future cardiovascular disease events in the general Japanese population: the Takashima Study. J Hum Hypertens. 2014; 28(5): 323–327.
  11. Ohishi M, Tatara Y, Ito N, et al. The combination of chronic kidney disease and increased arterial stiffness is a predictor for stroke and cardiovascular disease in hypertensive patients. Hypertens Res. 2011; 34(11): 1209–1215.
  12. Blacher J, Safar M, Guerin A, et al. Aortic pulse wave velocity index and mortality in end-stage renal disease. Kidney Int. 2003; 63(5): 1852–1860.
  13. Shroff RC, McNair R, Figg N, et al. Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis. Circulation. 2008; 118(17): 1748–1757.
  14. Wang MC, Tsai WC, Chen JY, et al. Stepwise increase in arterial stiffness corresponding with the stages of chronic kidney disease. Am J Kidney Dis. 2005; 45(3): 494–501.
  15. Briet M, Collin C, Karras A, et al. Nephrotest Study Group. Arterial remodeling associates with CKD progression. J Am Soc Nephrol. 2011; 22(5): 967–974.
  16. Sanghavi S, Vassalotti JA. Practical use of home blood pressure monitoring in chronic kidney disease. Cardiorenal Med. 2014; 4(2): 113–122.
  17. Wijkman M, Länne T, Engvall J, et al. Masked nocturnal hypertension--a novel marker of risk in type 2 diabetes. Diabetologia. 2009; 52(7): 1258–1264.
  18. Schernthaner G, Ritz E, Philipp T, et al. Night time blood pressure in diabetic patients--the submerged portion of the iceberg? Nephrol Dial Transplant. 1999; 14(5): 1061–1064.
  19. Timio M, Lolli S, Verdura C, et al. Circadian blood pressure changes in patients with chronic renal insufficiency: a prospective study. Ren Fail. 1993; 15(2): 231–237.
  20. Covic A, Goldsmith D. Ambulatory blood pressure monitoring: an essential tool for blood pressure assessment in uraemic patients. Nephrol Dial Transplant. 2002; 17(10): 1737–1741.
  21. Timio M, Venanzi S, Lolli S, et al. "Non-dipper" hypertensive patients and progressive renal insufficiency: a 3-year longitudinal study. Clin Nephrol. 1995; 43(6): 382–387.
  22. Ishikawa J, Shimizu M, Hoshide S, et al. Cardiovascular risks of dipping status and chronic kidney disease in elderly Japanese hypertensive patients. J Clin Hypertens (Greenwich). 2008; 10(10): 787–794.
  23. Ewen S, Ukena C, Linz D, et al. The sympathetic nervous system in chronic kidney disease. Curr Hypertens Rep. 2013; 15(4): 370–376.
  24. Cohen DL, Huan Y, Townsend RR. Ambulatory blood pressure in chronic kidney disease. Curr Hypertens Rep. 2013; 15(3): 160–166.
  25. Hermida RC, Ayala DE, Mojón A, et al. Bedtime dosing of antihypertensive medications reduces cardiovascular risk in CKD. J Am Soc Nephrol. 2011; 22(12): 2313–2321.
  26. Taylor KS, Heneghan CJ, Stevens RJ, et al. Heterogeneity of prognostic studies of 24-hour blood pressure variability: systematic review and meta-analysis. PLoS One. 2015; 10(5): e0126375.
  27. Ma Y, Zhou L, Dong J, et al. Arterial stiffness and increased cardiovascular risk in chronic kidney disease. Int Urol Nephrol. 2015; 47(7): 1157–1164.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl