Abstract 15372: Improvements in Ambulatory Blood Pressure Variability Translate into Inhibition of Cardiovascular and Renal Injury in Hypertensive Patients with Chronic Kidney Disease
Cardiovascular and renal complications are the most common cause of death in hypertensive patients with chronic kidney disease (CKD). Several studies have shown that target organ damage and prognosis more closely associated with ambulatory BP than with office BP. Ambulatory short-term BP variability is recently suggested to reflect atherosclerotic vascular changes. In this study, we firstly examined whether ambulatory BP variability is associated with cardiovascular injury in non-dialysis CKD patients, and secondary investigated whether the improvement in ambulatory BP variability translates into the inhibition of renal and cardiovascular injury in non-dialysis and dialysis CKD patients. In cross-sectional analysis of 111 consecutive hypertensive CKD patients, not only daytime and nighttime ambulatory BP but also nighttime BP variability were significantly positively associated with left ventricular mass index (LVMI) after adjustment for the covariate by the multivariable linear regression analysis (P=0.048). Nighttime BP variability was also significantly and positively associated with baPWV after adjustment with confounding factors (P=0.028). We next investigated whether the improvement in ambulatory BP variability translates into the inhibition of renal injury by using the angiotensin II type 1 receptor blocker (ARB) in 30 hypertensive patients with diabetic nephropathy. Multiple regression analysis showed a significant positive correlation between ambulatory BP variability and urinary protein excretion in these patients (P=0.008). Finally we examined whether the inhibitory effects of ARB on left ventricular hypertrophy in 40 hemodialysis CKD patients were partly mediated by the improvement in ambulatory BP variability. Multiple regression analysis showed a positive significant correlation between a change in nighttime BP variability and a change in LVMI (P=0.030). Collectively, these results indicate that increase in ambulatory short-term BP variability is related to the further renal deterioration and development of cardiovascular complication in CKD patients, and suggest that BP lowering strategy with a concomitant suppression of ambulatory BP variability may have an additional advantage in these patients.
- © 2012 by American Heart Association, Inc.