Relationship Between Within-Visit Blood Pressure Variability and Kidney Function in Patients with Arterial Hypertension

ORIGINAL ARTICLE
Andrey Y. Kravchenko, PhD, ScD; Anna A. Chernykh; Andrey V. Budnevsky, PhD, ScD; Evgeniy S. Ovsyannikov, PhD*; Alexey V. Chernov, PhD, ScD; Anna A. Feskova

Voronezh State Medical University named after N.N. Burdenko; Voronezh, the Russian Federation

*Corresponding author: Evgeniy S. Ovsyannikov, PhD. Department of faculty therapy, Voronezh State Medical University named after N.N. Burdenko. Voronezh, Russia.  E-mail: ovses@yandex.ru.

Published: June 16, 2017.  doi: 10.21103/Article7(2)_OA1

Abstract: 

The main purpose of this study was to investigate the features of within-visit blood pressure variability (BPV) in patients with arterial hypertension (AH) and to assess the relationship of those features to impaired renal filtration.
Material and Methods: The study included 120 patients with AH Stages I and II (ESH/ESC, 2013): 58(48.3%) men and 62(51.7%) women aged from 22 to 73 years (mean age 58.7±15 years). Average duration of AH was 15.0±6.7 years. BP was measured three times during visit. BP was measured three times at 2-minute intervals during one visit. Within-visit BPV was evaluated by the presence of an absolute difference (AD) between any two readings of three SBP measurements of more than 5mmHg. All patients underwent a comprehensive examination, which included blood and urine tests, kidney ultrasound, assessment of blood levels of creatinine and TnT, and calculation of GFR.
Results: Depending on the response of BP to repeated measurements, three types of BPV were identified. A prognostically unfavorable type of BPV, which is characterized by SBP-AD >5mmHg between the third and first measurements, was identified. Patients of this group had the lowest eGFR value that indicates more pronounced renal damage, and, as a consequence, worse prognosis. Also in these patients, there was an increase in TnT level, which is a predictor of the development of adverse cardiovascular complications.

Keywords: 
arterial hypertension ● blood pressure variability ● glomerular filtration rate ● chronic kidney disease
References: 
  1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, Chen J, He J. Global Disparities of Hypertension Prevalence and Control: A Systematic Analysis of Population-Based Studies From 90 Countries. Circulation. 2016;134(6):441-50. doi: 10.1161/CIRCULATIONAHA.115.018912.
  2. The Demographic Yearbook of Russia. Statistical handbook.  Rosstat. - M., 2015.
  3. Кravchenko AYa, Chernykh AA, Budnevsky AV. Variability of arterial pressure and renal function.  Klin Med (Mosk). 2016; 94(4):245-9.
  4. Кravchenko AYa, Chernykh AA, Budnevsky AV. Variability of arterial pressure in patients with arterial hypertension and overweight. Cardiovascular Therapy and Prevention (Mosk). 2016;15(S):100.
  5. Schillaci G, Bilo G, Pucci G, Laurent S, Macquin-Mavier I, Boutouyrie P,et al.  Relationship between short-term blood pressure variability and large-artery stiffness in human hypertension: findings from 2 large databases. Hypertension. 2012;60(2):369-77. doi: 10.1161/HYPERTENSIONAHA.112.197491.
  6. Pringle E, Phillips C, Thijs L, Davidson C, Staessen JA, de Leeuw PW, et al.; Syst-Eur investigators. Systolic blood pressure variability as a risk factor for stroke and cardiovascular mortality in the elderly hypertensive population. J Hypertens. 2003,21(12):2251–7.
  7.  Sega R, Corrao G, Bombelli M, Beltrame L, Facchetti R, Grassi G, et al. Blood pressure variability and organ damage in a general population: results from the PAMELA Study (Pressioni Arteriose Monitorate e Loro Associazioni). Hypertension. 2002;39(2 Pt 2):710–4.
  8. Hansen TW, Thijs L, Li Y, Boggia J, Kikuya M, Björklund-Bodegård K, et al.; International Database on Ambulatory Blood Pressure in Relation to Cardiovascular Outcomes Investigators. Prognostic value of reading-to-reading blood pressure variability over 24 hours in 8938 subjects from 11 populations. Hypertension. 2010;55(4):1049–57. doi: 10.1161/HYPERTENSIONAHA.109.140798.
  9. Kikuya M, Hozawa A, Ohokubo T, Tsuji I, Michimata M, Matsubara M, et al. Prognostic significance of blood pressure and heart rate varisbilities: the Ohasama Study. Hypertension. 2000; 36(5):901-6. 
  10. Wei FF, Li Y, Zhang L, Xu TY, Ding FH, Wang JG, Staessen JA.. Beat-to-beat, reading-to-reading, and day-to-day blood pressure variability in relation to organ damage in untreated Chinese. Hypertension. 2014;63(4):790–6. doi: 10.1161/HYPERTENSIONAHA.113.02681.
  11. Gansevoort RT, Correa-Rotter R, Hemmelgarn BR, Jafar TH, Heerspink HJ, Mann JF, et al. Chronic kidney disease and cardiovascular risk: epidemiology, mechanisms, and prevention. Lancet. 2013;382(9889):339–52. doi: 10.1016/S0140-6736(13)60595-4.
  12. Cerasola G, Cottone S, Mulè G. The progressive pathway of microalbuminuria: from early marker of renal damage to strong cardiovascular risk predictor. J Hypertens. 2010;28(12):2357–69. doi: 10.1097/HJH.0b013e32833ec377.
  13. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34(28):2159-219. doi: 10.1093/eurheartj/eht151
  14. Li Y, Liu J, Wang W, Zhao D.The association between within-visit blood pressure variability and carotid artery atherosclerosis in general population. PLoS One. 2014;9(5):e97760. doi: 10.1371/journal.pone.0097760.
  15. Tatasciore A1, Renda G, Zimarino M, Soccio M, Bilo G, Parati G, et al. Awake systolic blood pressure variability correlates with target-organ damage in hypertensive subjects. Hypertension. 2007;50(2):325–32.
  16. Manios E, Tsagalis G, Tsivgoulis G, Barlas G, Koroboki E, Michas F, et al. Time rate of blood pressure  variation is associated with impaired renal function in hypertensive patients. J Hypertens. 2009;27(11):2244–8. doi: 10.1097/HJH.0b013e328330a94f.
  17. Okada H, Fukui M, Tanaka M, Inada S, Mineoka Y, Nakanishi N, et al. Visit-to-visit variability in systolic blood pressure is correlated with diabetic nephropathy and atherosclerosis in patients with type 2 diabetes. Atherosclerosis. 2012; 220(1):155–9. doi: 10.1016/j.atherosclerosis.2011.10.033.
  18. Shin JH,  Shin J,  Kim BK,  Lim Y-H,  Park H-C,  Choi SI, et al. Within-visit blood pressure variability: relevant factors in the general population. J Hum Hypertens. 2013;27 (5):328-34. doi: 10.1038/jhh.2012.39.
  19. Rahman M, Pressel S, Davis BR, Nwachuku C, Wright Jr JT, Whelton PK et al; ALLHAT Collaborative Research Group. Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med. 2006;144(3):172–80.
  20. Xu RY, Zhu XF, Yang Y, Ye P. High-sensitive cardiac troponin T.  J Geriatr Cardiol. 2013;10(1):102–9. doi: 10.3969/j.issn.1671-5411.2013.01.015.
  21. Stacy SR, Suarez-Cuervo C, Berger Z, Wilson LM, Yeh HC, Bass EB, Michos ED.  Role of troponin in patients with chronic kidney disease and suspected acute coronary syndrome: a systematic review. Ann Intern Med. 2014;161(7):502-12. doi: 10.7326/M14-0746.
  22. Newby LK, Jesse RL, Babb JD, Christenson RH, De Fer TM, Diamond GA, et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2012; 60(23):2427-63. doi: 10.1016/j.jacc.2012.08.969.
  23. Hasegawa M, Ishii J, Kitagawa F, Kanayama K, Takahashi H, Ozaki Y, et al. Prognostic value of highly sensitive troponin T on cardiac events in patients with chronic kidney disease not on dialysis. Heart Vessels. 2013;28(4):473-9. doi: 10.1007/s00380-012-0273-2.
  24. Bjurman C, Petzold M, Venge P, Farbemo J, Fu ML, Hammarsten O. High-sensitive cardiac troponin, NT-proBNP, hFABP and copeptin levels in relation to glomerular filtration rates and a medical record of cardiovascular disease. Clin Biochem. 2015; 48(4-5):302-7. doi: 10.1016/j.clinbiochem.2015.01.008.
  25. Jaffe AS Chasing troponin: how low can you go if you can see the rise? [Editorial]. J Am Coll Cardiol 2006;48(9):1763-4
  26. Seliger SL, Hong SN, Christenson  RH, Kronmal R, Daniels LB, Lima JAC, et al. High Sensitive Cardiac Troponin T as an Early Biochemical Signature for Clinical and Subclinical Heart Failure: MESA (Multi-Ethnic Study of Atherosclerosis). Circulation. 2017;135(16):1494-1505. doi: 10.1161/CIRCULATIONAHA.116.025505.
  27. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int (Suppl.) 2013; 3:1-150.
  28. Smirnov AV, Schilov EM, Dobronravov VA, Kayukov IG, Bobkova IN, Shcveczov MU, et al. National recommendations. National recommendations. Chronic illness of kidneys: main principles of screening, diagnostics, preventive maintenance and approaches to treatment. Klinicheskaja nefrologija. 2012;4:4-26.
  29. Stevens LA, Li S, Kurella Tamura M, Chen SC, Vassalotti JA, Norris KC, et al. Comparison of the CKD Epidemiology Collaboration (CKD-EPI) and Modification of Diet in Renal Disease (MDRD) study equations: risk factors for and complications of CKD and mortality in the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis. 2011;57(3 Suppl 2):S9-16. doi: 10.1053/j.ajkd.2010.11.007.
  30. Gorbunov VM. Modern ideas about the variability of blood pressure. Racional'naja farmakoterapija v kardiologii.  2012;8:810-818.
  31. Okada R, Yasuda Y, Tsushita K, Wakai K, Hamajima N, Matsuo S.Within-visit blood pressure variability is associated with prediabetes and diabetes. Sci Rep. 2015;5:7964. doi: 10.1038/srep07964.
  32. Panina IY,  Petrishchev NN, Smirnov AV,  Rumyantsev ASh, Degtereva OA. Arterial hypertension and endothelial dysfunction in chronic kidney disease.  Arterial'naia gipertenziia. 2006;4:352-357.
  33. Smirnov AB, Dobronravov VA,  Kaiukov IG. Cardio-Renal Continuum: Pathogenetic Basics of Preventive Nephrology. Nephrology (Saint-Petersburg). 2005; 9(3):7-12.
  34. Amann К, Gross ML, Ritz Е. Pathophysiology underlying accelerated atherogenesis in renal disease: closing in on the target. J Am Soc Nephrol. 2004;15(6):1664-6.
  35. Musial К, Zwolinska D, Polak-Jonkisz D, Berny U, Szprynger K, Szczepanska M. Serum VCAM-1, ICAM-1, and L-selectin levels in children and young adults with chronic renal failure. Pediatr Nephrol. 2005; 20(1):52-5.

The fully formatted PDF version is available.
Download Article
International Journal of Biomedicine. 2017;7(2):91-95. © 2017 International Medical Research and Development Corporation. All rights reserved.