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

Clin J Am Soc Nephrol. 2016 Mar 7;11(3):471-80. doi: 10.2215/CJN.04660415. Epub 2016 Feb 18.

Abstract

Background and objectives: 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.

Design, setting, participants, & measurements: 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.

Results: 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.

Conclusions: Higher visit-to-visit variability of BP is associated with higher risk of renal outcomes independent of mean BP.

Keywords: antihypertensive agents; blood pressure; blood pressure variability; cardiovascular diseases; clinical trial; follow-up studies; glomerular filtration rate; hypertension; kidney failure, chronic; random allocation.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Amlodipine / therapeutic use
  • Antihyperkalemic Agents / therapeutic use
  • Blood Pressure Determination
  • Blood Pressure* / drug effects
  • Chlorthalidone / therapeutic use
  • Disease Progression
  • Female
  • Glomerular Filtration Rate*
  • Humans
  • Hypertension / complications*
  • Hypertension / diagnosis
  • Hypertension / drug therapy
  • Hypertension / physiopathology*
  • Kidney / physiopathology*
  • Kidney Failure, Chronic / etiology
  • Kidney Failure, Chronic / physiopathology
  • Lisinopril / therapeutic use
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Proportional Hazards Models
  • Randomized Controlled Trials as Topic
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / etiology*
  • Renal Insufficiency, Chronic / physiopathology*
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Antihyperkalemic Agents
  • Amlodipine
  • Lisinopril
  • Chlorthalidone