Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial.

McMullan CJ, Lambers Heerspink HJ, Parving HH, Dwyer JP, Forman JP, de Zeeuw D
Am J Kidney Dis. 2014 64 (5): 714-22

PMID: 25064674 · DOI:10.1053/j.ajkd.2014.06.008

BACKGROUND - Increased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points. However, few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney disease outcomes. We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy.

STUDY DESIGN - Observational analysis of IDNT (Irbesartan Diabetic Nephropathy Trial) and the RENAAL (Reduction of End Points in Non-Insulin-Dependent Diabetes With the Angiotensin II Antagonist Losartan) Study.

SETTING & PARTICIPANTS - 2,739 participants with type 2 diabetes and nephropathy with at least 1 year of blood pressure measurements available.

PREDICTORS - Systolic blood pressure visit-to-visit variability was calculated from the SD of the systolic blood pressure from 4 visits occurring 3-12 months postrandomization.

OUTCOMES - The kidney disease outcome was defined as time to confirmed doubling of serum creatinine level, end-stage renal disease, or death; the cardiovascular outcome was defined as time to cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, or revascularization.

RESULTS - Mean visit-to-visit variability in systolic blood pressure from 3 to 12 months postrandomization was 12.0±6.8(SD)mmHg. Following this ascertainment period, there were 954 kidney disease and 542 cardiovascular events. Greater systolic blood pressure visit-to-visit variability was associated independently with increased risk of the composite kidney disease end point (HR per 1-SD increment, 1.08 [95%CI, 1.01-1.16]; P=0.02) and end-stage renal disease, but not with the cardiovascular outcome.

LIMITATIONS - Observational study with the potential for confounding.

CONCLUSIONS - In diabetic individuals with nephropathy, systolic blood pressure visit-to-visit variability is associated independently with hard kidney disease outcomes.

Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

MeSH Terms (20)

Aged Angiotensin II Type 1 Receptor Blockers Biphenyl Compounds Blood Pressure Cardiovascular Diseases Cohort Studies Diabetes Mellitus, Type 2 Diabetic Nephropathies Double-Blind Method Female Follow-Up Studies Humans Irbesartan Kidney Male Middle Aged Office Visits Prospective Studies Tetrazoles Treatment Outcome

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