University of Massachusetts Medical School Faculty Publications

Title

Association of BP Variability with Mortality among African Americans with CKD

UMMS Affiliation

Department of Medicine, Division of Cardiovascular Medicine

Publication Date

5-7-2013

Document Type

Article

Subjects

Blood Pressure; Kidney Diseases; Cardiovascular Diseases; African Americans

Disciplines

Cardiology | Cardiovascular Diseases | Epidemiology | Female Urogenital Diseases and Pregnancy Complications | Male Urogenital Diseases | Nephrology

Abstract

BACKGROUND AND OBJECTIVES: Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.

DESIGN, SETTING, PARTICIPANTS, and MEASUREMENTS: This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.

RESULTS: Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.

CONCLUSIONS: In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.

Rights and Permissions

Citation: Clin J Am Soc Nephrol. 2013 May;8(5):731-8. doi: 10.2215/CJN.10131012. Link to article on publisher's site

Related Resources

Link to Article in PubMed

Journal/Book/Conference Title

Clinical journal of the American Society of Nephrology : CJASN

PubMed ID

23493382