Dataset Information

Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease.

ABSTRACT:

Background and objectives

Central BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk.

Design, setting, participants, & measurements

In a prospective, longitudinal study (the Chronic Renal Insufficiency Cohort), central BP was measured in participants with CKD using the SphygmoCorPVx System. Cox proportional hazards models were used for analyses.

Results

Mean age of the participants (n=2875) was 60 years old. After a median follow-up of 5.5 years, participants in the highest quartile of brachial systolic BP (≥138 mm Hg) were at higher risk for the composite cardiovascular outcome (hazard ratio, 1.59; 95% confidence interval, 1.17 to 2.17; c statistic, 0.76) but not all-cause mortality (hazard ratio, 1.28; 95% confidence interval, 0.90 to 1.80) compared with those in the lowest quartile. Participants in the highest quartile of central systolic BP were also at higher risk for the composite cardiovascular outcome (hazard ratio, 1.69; 95% confidence interval, 1.24 to 2.31; c statistic, 0.76) compared with participants in the lowest quartile.

Conclusions

We show that elevated brachial and central BP measurements are both associated with higher risk of cardiovascular disease outcomes in patients with CKD. Measurement of central BP does not improve the ability to predict cardiovascular disease outcomes or mortality in patients with CKD compared with brachial BP measurement.

SUBMITTER: Rahman M

PROVIDER: S-EPMC5969462 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Publications

Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease.

Rahman Mahboob M Hsu Jesse Yenchih JY Desai Niraj N Hsu Chi-Yuan CY Anderson Amanda H AH Appel Lawrence J LJ Chen Jing J Cohen Debbie L DL Drawz Paul E PE He Jiang J Qiang Pan P Ricardo Ana C AC Steigerwalt Susan S Weir Matthew R MR Wright Jackson T JT Zhang Xiaoming X Townsend Raymond R RR

Clinical journal of the American Society of Nephrology : CJASN 20180223 4

<h4>Background and objectives</h4>Central BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk.<h4>Design, setting, participants, & measurements</h4>In a prospective, longitudinal study (the Chronic Renal Insuffici ...[more]

PMID: 29475992

Similar Datasets

Project description:BackgroundEmerging data favor central blood pressure (BP) over brachial cuff BP to predict cardiovascular and kidney events, as central BP more closely relates to the true aortic BP. Considering that patients with advanced chronic kidney disease (CKD) are at high cardiovascular risk and can have unreliable brachial cuff BP measurements (due to high arterial stiffness), this population could benefit the most from hypertension management using central BP measurements.ObjectiveTo assess the feasibility and efficacy of targeting central BP as opposed to brachial BP in patients with CKD G4-5.DesignPragmatic multicentre double-blinded randomized controlled pilot trial.SettingSeven large academic advanced kidney care clinics across Canada.PatientsA total of 116 adults with CKD G4-5 (estimated glomerular filtration rate [eGFR] < 30 mL/min) and brachial cuff systolic BP between 120 and 160 mm Hg. The key exclusion criteria are 1) ≥ 5 BP drugs, 2) recent acute kidney injury, myocardial infarction, stroke, heart failure or injurious fall, 3) previous kidney replacement therapy.MethodsDouble-blind randomization to a central or a brachial cuff systolic BP target (both < 130 mm Hg) as measured by a validated central BP device. The study duration is 12 months with follow-up visits every 2 to 4 months, based on local practice. All other aspects of CKD management are at the discretion of the attending nephrologist.OutcomesPrimary Feasibility: Feasibility of a large-scale trial based on predefined components. Primary Efficacy: Carotid-femoral pulse wave velocity at 12 months. Others: Efficacy (eGFR decline, albuminuria, BP drugs, and quality of life); Events (major adverse cardiovascular events, CKD progression, hospitalization, mortality); Safety (low BP events and acute kidney injury).LimitationsMay be challenging to distinguish whether central BP is truly different from brachial BP to the point of significantly influencing treatment decisions. Therapeutic inertia may be a barrier to successfully completing a randomized trial in a population of CKD G4-5. These 2 aspects will be evaluated in the feasibility assessment of the trial.ConclusionThis is the first trial to evaluate the feasibility and efficacy of using central BP to manage hypertension in advanced CKD, paving the way to a future large-scale trial.Trial registrationclinicaltrials.gov (NCT05163158).

Dataset Information

Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease.

Background and objectives

Design, setting, participants, & measurements

Results

Conclusions

Publications

Central Blood Pressure and Cardiovascular Outcomes in Chronic Kidney Disease.

Similar Datasets

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