Key result
Aortic stiffness and central systolic blood pressure were independently associated with orthostatic SBP fall in patients with CKD (OR for cfPWV 1.46; 95% CI 1.16-1.84; p=0.001).
Why the study?
Patients with CKD are at high risk for cardiovascular events, and the authors hypothesized that orthostatic hypotension is associated with arterial stiffness and central blood pressure in this population.
Are aortic stiffness and central systolic blood pressure associated with orthostatic blood pressure fall in patients with chronic kidney disease?
Observational (n=146)
No
Are aortic stiffness and central systolic blood pressure associated with orthostatic blood pressure fall in patients with chronic kidney disease?
Odds Ratio: 1.46 (95% CI 1.16–1.84)
p-value: p=0.001
May flag aortic stiffness as a modifiable factor in CKD orthostatic hypotension; leaves open causal effects and intervention benefits.
OBJECTIVE: Orthostatic hypotension (OH) has a significant association with cardiovascular disease. OH becomes more common in older age, as does arterial stiffness, shown to be independently associated with impaired baroreflex sensitivity and OH. Measurement of arterial compliance and central blood pressures are increasingly important, with evidence that central BP more closely correlates to end-organ damage and mortality than peripheral measurements. Patients with chronic kidney disease (CKD) are high risk for cardiovascular events, which can be predicted through measures of arterial compliance. We hypothesised that OH is associated with arterial stiffness and central blood pressure in CKD patients. DESIGN/SETTING: We tested this hypothesis within the arterial compliance and oxidant stress as predictors of loss of renal function, morbidity and mortality in chronic kidney disease (ACADEMIC) study, a single-centre prospective observational study of the progression of arterial stiffness and renal function. PARTICIPANTS: One hundred and forty-six patients with CKD 3 or 4. MEASUREMENTS: (ALAM Medical, France). RESULTS: Twenty-three patients had a postural SBP fall (prevalence 15.8%), with mean drop 7 mmHg. Patients with OH had higher cfPWV (15.2 m/s vs 12.7 m/s in patients without OH, p < 0.001) and central SBP (147.5 vs 135.7, p = 0.012). Regression analysis gave an odds ratio (OR) of orthostatic SBP fall for cfPWV of 1.46 (95% CI 1.16-1.84, p = 0.001) and 1.03 for cSBP (95% CI 1.004-1.06, p = 0.024) after adjustment for cardiovascular risk factors. CONCLUSION: Aortic stiffness and central SBP are independently associated with orthostatic SBP fall in CKD patients. This suggests that enhanced arterial stiffness may be an underlying mechanism in baroreflex dysfunction, and may partly explain the vascular risk in CKD patients.
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Kirkham et al. (2019) conducted an observational in Chronic kidney disease (n=146). Aortic stiffness and central systolic blood pressure was evaluated on Orthostatic SBP fall (OR 1.46, 95% CI 1.16-1.84, p=0.001). Aortic stiffness and central systolic blood pressure were independently associated with orthostatic SBP fall in patients with CKD (OR for cfPWV 1.46; 95% CI 1.16-1.84; p=0.001).
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