Incorporating 24-hour central systolic blood pressure into blood pressure phenotypes significantly improved discrimination for left ventricular hypertrophy (NRI 0.192; 95% CI 0.085-0.298; P<0.001).
Cross-Sectional (n=2,589)
Yes
Does incorporating 24-hour central systolic blood pressure into blood pressure phenotypes improve discrimination of target organ damage in non-dialysis patients with chronic kidney disease?
Incorporating 24-hour central systolic blood pressure into standard blood pressure phenotypes improves risk stratification for target organ damage in non-dialysis CKD patients.
Effect estimate: NRI 0.192 (95% CI 0.085-0.298)
p-value: p=<0.001
The incremental value of 24-hour central systolic blood pressure in identifying target organ damage based on blood pressure phenotypes remains unclear. This multicenter, cross-sectional study enrolled 2589 non-dialysis patients with chronic kidney disease. Clinic and ambulatory brachial blood pressure were used to define blood pressure phenotypes. The net reclassification index and logistic regression analyses were performed. 24-h central systolic blood pressure gradually elevated across four blood pressure phenotypes with a linear trend (P-trend <0.001). Incorporating 24-h central systolic blood pressure into blood pressure phenotypes significantly improved target organ damage discrimination, particularly 24-h central systolic blood pressure with c2 calibration (mean arterial pressure and diastolic blood pressure calibration method) for left ventricular hypertrophy (NRI = 0.192, 95% CI 0.085-0.298, P < 0.001). Multivariable logistic regression revealed that, compared with normotension without central systolic hypertension (c2 calibration), only masked hypertension and sustained hypertension with central systolic hypertension (c2 calibration) had significantly increased odds of both left ventricular hypertrophy (ORs: 3.220 95% CI, 1.861-5.537; P < 0.001 and 4.054 95% CI, 2.772-5.996; P < 0.001) and carotid hypertrophy (ORs: 2.059 95% CI, 1.240-3.461; P = 0.006 and 1.368 95% CI, 1.001-1.860; P = 0.049). Moreover, the prevalence of kidney injury was higher in the masked hypertension and sustained hypertension groups with central systolic hypertension (c2 calibration) than in the group without central systolic hypertension (c2 calibration). 24-h central systolic blood pressure may provide additional value for target organ damage risk stratification based on blood pressure phenotypes in non-dialysis patients with chronic kidney disease.
Chen et al. (Thu,) conducted a cross-sectional in Chronic kidney disease (n=2,589). 24-hour central systolic blood pressure vs. Blood pressure phenotypes alone / Normotension without central systolic hypertension was evaluated on Target organ damage discrimination (left ventricular hypertrophy) (NRI 0.192, 95% CI 0.085-0.298, p=<0.001). Incorporating 24-hour central systolic blood pressure into blood pressure phenotypes significantly improved discrimination for left ventricular hypertrophy (NRI 0.192; 95% CI 0.085-0.298; P<0.001).