Key result
Nighttime SBP load is independently linked to higher LVMI in non-hypertensive, non-diabetic CKD.
Why the study?
The impacts of blood pressure load on target-organ damage in patients with chronic kidney disease are largely unclear, especially independent of ambulatory blood pressure levels.
Does nighttime systolic blood pressure load correlate with target-organ damage independent of 24-hour blood pressure levels in patients with pre-dialysis chronic kidney disease?
Cross-Sectional (n=1,219)
No
Does nighttime systolic blood pressure load correlate with target-organ damage independent of 24-hour blood pressure levels in patients with pre-dialysis chronic kidney disease?
Nighttime systolic blood pressure load correlates with target-organ damage in non-diabetic CKD patients, suggesting that ABPM load metrics provide independent prognostic value beyond average blood pressure levels alone.
Nighttime SBP load may flag higher LVH risk in non-diabetic normotensive CKD; leaves open whether load metrics improve stratification beyond ABPM averages.
BACKGROUND: The impacts of blood pressure (BP) load on target-organ damage in patients with chronic kidney disease (CKD) are largely unclear. We examined whether BP load is correlated with target-organ damage (TOD) in Chinese CKD patients independent of BP level. METHODS: We recruited 1219 CKD patients admitted to our hospital division in this cross-sectional study. The TOD were measured by estimated glomerular filtration rate (eGFR), proteinuria, left ventricular mass index (LVMI) and carotid intima-media thickness (cIMT) in this study. Univariate and multivariate linear analyses were used to evaluate the relationship between systolic blood pressure (SBP) load, diastolic blood pressure (DBP) load and these renal, cardiovascular parameters. RESULTS: In multivariable-adjusted models, BP load and ambulatory BP levels both independently correlated with LVMI, eGFR and proteinuria in all groups of CKD patients (p<0.05), 24-h SBP correlated with cIMT only in non-diabetic CKD patients without hypertension (p<0.05), while nighttime SBP load was associated with cIMT only in non-diabetic CKD patients (p<0.05). Furthermore, nighttime SBP load additionally increased coefficient of determination (R(2)) and correlated with LVMI, proteinuria in non-diabetic CKD patients without hypertension (R(2) = 0.034, P<0.001 and R(2) = 0.012, P = 0.006 respectively) and LVMI, cIMT, eGFR in non-diabetic CKD patients with hypertension (R(2)>0.008, P<0.05) in multivariable-adjusted model which already including the 24-h BP. BP load did not refine this correlation based on the 24-h BP level in diabetic CKD patients. CONCLUSION: Night-time SBP load was correlated with TOD in patients with non-diabetic chronic kidney disease independent of BP level.
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Wang et al. (2015) conducted a cross-sectional in Chronic Kidney Disease (CKD) (n=1,219). Nighttime systolic blood pressure (SBP) load vs. 24-hour ambulatory blood pressure levels and normal BP load was evaluated on Left ventricular mass index (LVMI) variance in non-diabetic CKD patients without hypertension (Model 3 multivariable adjustment including 24-h BP) (β 0.238, 95% CI 0.105-0.355, p=<0.001). Nighttime systolic blood pressure load was independently correlated with increased left ventricular mass index (β 0.238, p<0.001) in non-diabetic chronic kidney disease patients without hypertension, independent of 24-hour ambulatory blood pressure levels.
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