Dataset Information

Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT.

ABSTRACT: Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after participants were randomized to chlorthalidone, amlodipine, or lisinopril. The composite outcome included incident ESRD after assessment of SD of systolic BP or ?50% decline in eGFR between 24 months and 48 or 72 months after randomization. We repeated the analyses using average real variability and peak value of systolic BP and for visit-to-visit variability of diastolic BP.Over a mean follow-up of 3.5 years, 297 outcomes occurred. After multivariable adjustment, including baseline eGFR and mean systolic BP, the hazard ratios for the composite end point were 1.29 (95% confidence interval [95% CI], 0.75 to 2.22), 1.76 (95% CI, 1.06 to 2.91), 1.46 (95% CI, 0.88 to 2.45), and 2.05 (95% CI, 1.25 to 3.36) for the second through fifth (SD of systolic BP =6.63-8.82, 8.83-11.14, 11.15-14.56, and >14.56 mmHg, respectively) versus the first (SD of systolic BP <6.63 mmHg) quintile of SD of systolic BP, respectively (P trend =0.004). The association was similar when ESRD and a 50% decline in eGFR were analyzed separately, for other measures of visit-to-visit variability of systolic BP, and for visit-to-visit variability of diastolic BP.Higher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.

SUBMITTER: Whittle J

PROVIDER: S-EPMC4791814 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT.

Whittle Jeff J Lynch Amy I AI Tanner Rikki M RM Simpson Lara M LM Davis Barry R BR Rahman Mahboob M Whelton Paul K PK Oparil Suzanne S Muntner Paul P

Clinical journal of the American Society of Nephrology : CJASN 20160218 3

<h4>Background and objectives</h4>Increased visit-to-visit variability of BP is associated with cardiovascular disease risk. We examined the association of visit-to-visit variability of BP with renal outcomes among 21,245 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.<h4>Design, setting, participants, & measurements</h4>We measured mean BP and visit-to-visit variability of BP, defined as SD, across five to seven visits occurring 6-28 months after ...[more]

PMID: 26912544

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Project description:Background and objectivesHypertension is the most important treatable risk factor for cardiovascular outcomes. Many patients with CKD are elderly, but the ideal BP in these individuals is unknown.Design, setting, participants, & measurementsFrom among 339,887 patients with incident eGFR<60 ml/min per 1.73 m(2), we examined associations of systolic BP (SBP) and diastolic BP (DBP) with all-cause mortality, incident coronary heart disease (CHD), ischemic strokes, and ESRD from the time of developing CKD until the end of follow-up (July 26, 2013, for mortality, CHD, and stroke, and December 31, 2011, for ESRD) in multivariable-adjusted survival models categorized by patients' age.ResultsOf the total cohort, 300,424 (88%) had complete data for multivariable analysis. Both SBP and DBP showed a U-shaped association with mortality. SBP displayed a linear association with CHD, stroke, and ESRD, whereas DBP showed no consistent association with either. SBP>140 mmHg was associated with higher incidence of all examined outcomes, but with an incremental attenuation of the observed risk in older compared with younger patients (P<0.05 for interaction) The adjusted hazard ratios and 95% confidence intervals associated with SBP?170 mmHg (compared with 130-139 mmHg) in patients <50, 50-59, 60-69, 70-79, and ?80 years were 1.95 (1.34 to 2.84), 2.01 (1.75 to 2.30), 1.68 (1.49 to 1.89), 1.39 (1.25 to 1.54), and 1.30 (1.17 to 1.44), respectively. The risk of incident CHD, stroke, and ESRD was incrementally higher with higher SBP in patients aged <80 years but showed no consistent association in those aged ?80 years (P<0.05 for interaction for all outcomes).ConclusionsIn veterans with incident CKD, SBP showed different associations in older versus younger patients. The association of higher SBP with adverse outcomes was present but markedly reduced in older individuals, especially in those aged ?80 years. Elevated DBP showed no consistent association with vascular outcomes in patients with incident CKD.

Dataset Information

Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT.

Publications

Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT.

Similar Datasets

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