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Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate.
Arch Intern Med. 2006 Apr 24; 166(8):846-52.AI

Abstract

BACKGROUND

Most healthy people exhibit a decrease in systolic blood pressure (SBP) at night. A drop of less than 10% from mean daytime values (nondipping) is associated with chronic kidney disease, insulin resistance, and cardiovascular events. Whether nondipping precedes a decline in renal function remains unclear. We hypothesized that nondipping would predict a decline in the glomerular filtration rate (GFR) over time.

METHODS

Consecutive patients referred for ambulatory blood pressure monitoring were included in our retrospective cohort if they had a serum creatinine level noted at the time of their ambulatory blood pressure recording and a follow-up creatinine level recorded at least 1 year later. Mean day and night SBPs were compared (nighttime SBP-daytime [corrected] SBP ratio). We defined nondipping as a nighttime [corrected] SBP-daytime [corrected] SBP ratio higher than 0.90. The GFR was calculated using the Modification of Diet in Renal Disease 4-variable equation.

RESULTS

Of 322 patients included, 137 were dippers and 185 were nondippers; their mean baseline GFRs were 80.5 mL/min per 1.73 m(2) and 76.4 mL/min per 1.73 m(2), respectively. During a median follow-up of 3.2 years, the GFRs remained stable among dippers (mean change, 1.3%) but declined among nondippers (mean change, -15.9%) (P<.001). The creatinine levels increased by more than 50% in 2 dippers (1.5%) and in 32 nondippers (17.3%) (P<.001). These findings persisted after adjustment for other predictors of GFR decline.

CONCLUSION

Blunted diurnal blood pressure variation is associated with a subsequent deterioration in renal function that is independent of SBP load and other risk factors for renal impairment.

Authors+Show Affiliations

Davidson MB
Department of General Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Hix JK
No affiliation info available
Vidt DG
No affiliation info available
Brotman DJ
No affiliation info available

MeSH

AgedBlood PressureBlood Pressure Monitoring, AmbulatoryCircadian RhythmCreatinineFemaleFollow-Up StudiesGlomerular Filtration RateHumansKidney DiseasesMaleMiddle AgedPrognosisRetrospective StudiesRisk Factors

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

16636209

Clinical Trial Links

Chronotherapy Versus Conventional BP Control to Correct Abnormal Circadian BP Pattern in Kidney Transplant Recipients

Citation

Davidson, Michael B., et al. "Association of Impaired Diurnal Blood Pressure Variation With a Subsequent Decline in Glomerular Filtration Rate." Archives of Internal Medicine, vol. 166, no. 8, 2006, pp. 846-52.
Davidson MB, Hix JK, Vidt DG, et al. Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Arch Intern Med. 2006;166(8):846-52.
Davidson, M. B., Hix, J. K., Vidt, D. G., & Brotman, D. J. (2006). Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. Archives of Internal Medicine, 166(8), 846-52.
Davidson MB, et al. Association of Impaired Diurnal Blood Pressure Variation With a Subsequent Decline in Glomerular Filtration Rate. Arch Intern Med. 2006 Apr 24;166(8):846-52. PubMed PMID: 16636209.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of impaired diurnal blood pressure variation with a subsequent decline in glomerular filtration rate. AU - Davidson,Michael B, AU - Hix,John K, AU - Vidt,Donald G, AU - Brotman,Daniel J, PY - 2006/4/26/pubmed PY - 2006/5/10/medline PY - 2006/4/26/entrez SP - 846 EP - 52 JF - Archives of internal medicine JO - Arch Intern Med VL - 166 IS - 8 N2 - BACKGROUND: Most healthy people exhibit a decrease in systolic blood pressure (SBP) at night. A drop of less than 10% from mean daytime values (nondipping) is associated with chronic kidney disease, insulin resistance, and cardiovascular events. Whether nondipping precedes a decline in renal function remains unclear. We hypothesized that nondipping would predict a decline in the glomerular filtration rate (GFR) over time. METHODS: Consecutive patients referred for ambulatory blood pressure monitoring were included in our retrospective cohort if they had a serum creatinine level noted at the time of their ambulatory blood pressure recording and a follow-up creatinine level recorded at least 1 year later. Mean day and night SBPs were compared (nighttime SBP-daytime [corrected] SBP ratio). We defined nondipping as a nighttime [corrected] SBP-daytime [corrected] SBP ratio higher than 0.90. The GFR was calculated using the Modification of Diet in Renal Disease 4-variable equation. RESULTS: Of 322 patients included, 137 were dippers and 185 were nondippers; their mean baseline GFRs were 80.5 mL/min per 1.73 m(2) and 76.4 mL/min per 1.73 m(2), respectively. During a median follow-up of 3.2 years, the GFRs remained stable among dippers (mean change, 1.3%) but declined among nondippers (mean change, -15.9%) (P<.001). The creatinine levels increased by more than 50% in 2 dippers (1.5%) and in 32 nondippers (17.3%) (P<.001). These findings persisted after adjustment for other predictors of GFR decline. CONCLUSION: Blunted diurnal blood pressure variation is associated with a subsequent deterioration in renal function that is independent of SBP load and other risk factors for renal impairment. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/16636209/Association_of_impaired_diurnal_blood_pressure_variation_with_a_subsequent_decline_in_glomerular_filtration_rate_ DB - PRIME DP - Unbound Medicine ER -