What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic Kidney Disease (CKD) not undergoing dialysis (n=588). Intervention: Reverse dipping blood pressure pattern vs. Dipping blood pressure pattern. Primary outcome: Time to all-cause mortality (HR 5.08, 95% CI 1.79~14.47, p=0.002).

October 7, 2016Scientific Reports37 citationsOpen Access

Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study

CWCheng WangTongji University ZYZengchun YeSun Yat-sen University YLYan LiUniversity of Chicago

Key Result

A reverse dipping blood pressure pattern was associated with a significantly higher risk of total mortality (HR 5.08) compared to a dipping pattern in chronic kidney disease patients not undergoing dialysis.

Study Design

Type

Cohort (n=588)

Multicenter

Structured PICO

Does a reverse dipping blood pressure pattern increase the risk of mortality, cardiovascular events, and renal events in non-dialysis CKD patients compared to a dipping pattern?

Population

588 Chinese patients aged 14 to 74 years with chronic kidney disease not undergoing dialysis, followed for a median of 35 months.

Exposure

Reverse dipping blood pressure pattern (higher systolic blood pressure at nighttime compared with daytime on 24-hour ambulatory blood pressure monitoring)

Comparator

Dipping blood pressure pattern (reduction in systolic blood pressure of ≥10% but <20% at nighttime compared with daytime)

Outcome

Time to all-cause mortality and time to cardiovascular mortalityhard clinical

Main Result

Hazard Ratio: 5.08 (95% CI 1.79–14.47)

Absolute Event Rate: 69.13% vs 10.9%

p-value: p=0.002

Limitations

All patients were from a single center
Patients underwent only one ABPM, so subsequent changes could not be ruled out
Selection bias due to excluding patients who refused to complete follow-up
Patients did not accept standard therapy, so drug effects could not be ruled out
Significant differences in baseline characteristics between groups may have affected results
Varied etiology of CKD among patients

Abstract

The "reverse dipping" blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a "dipper", "non-dipper" and "reverse dippers" was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio HR, 5.08; 95% confidence interval CI, 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis.

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