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Kidney Week

Abstract: PO2086

Importance of Continuous Blood Pressure Monitoring in CKD

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Andronesi, Andreea Gabriella, Fundeni Clinical Institute, Bucharest, Romania
  • Cristache, Cristina, Fundeni Clinical Institute, Bucharest, Romania
  • Obrisca, Bogdan, Fundeni Clinical Institute, Bucharest, Romania
  • Sorohan, Bogdan Marian, Fundeni Clinical Institute, Bucharest, Romania
  • Jurubita, Roxana Adriana, Fundeni Clinical Institute, Bucharest, Romania
  • Andronesi, Danut, Fundeni Clinical Institute, Bucharest, Romania
  • Lupusoru, Gabriela, Fundeni Clinical Institute, Bucharest, Romania
  • Lupusoru, Mircea, Carol Davila University of Medicine and Pharmacy, Physiology Department, Bucahrest, Romania
  • Ismail, Gener, Fundeni Clinical Institute, Bucharest, Romania
Background

A strong relationship exists between CKD and high blood pressure (BP), tight BP control is essential for delaying CKD progression and improving cardiovascular outcome. Automated blood pressure monitoring (ABPM) is associated with hypertension-related target-organ damage and cardiovascular outcomes compared with office-based BP in general population.

Methods

We performed a prospective study in CKD. Heart ultrasound and ABPM were performed at inclusion. Normative values for ABPM were defined according to AHA recommendation from 2019. Medical data were recorded for at least one year or until death. The aim was to analyze the correlation between ABPM and left ventricular (LV) changes and cardiovascular outcome.

Results

We included 339 pts (171F, mean age 60.1±14): 15.9% stage 1/2 , 31.8% stage 3, 19.7% stage 4. 66 were in HD, 24 in PD. Prevalence of increased BP readings was higher in advanced CKD- 21.5% in stage 1/2, 56.7% in stage 5. Mean diastolic load was higher in LV hypertrophy (35.6±29 vs 19.7±19.6 mmHg, p<0.05). We found a negative correlation between mean arterial pressure (MAP) and GFR (r=-0.457, p<0.05). MAP was higher in PD compared to HD (109.1 ± 17.6 vs 98.9±9.3 mmHg, p=0.01). Serum albumin had a weak negative correlation (r=-0.245, p=0.01) and fibrinogen a weak positive correlation (r=0.266, p=0.02) with mean systolic BP, and mean LDL-cholesterol (as an indirect marker of malnutrition) was lower in non-dipper (95.4±35.4 vs. 130.5±27.2 mg/dl, p<0.05), suggesting a negative influence on BP control of malnutrition and inflammation. 225 (72.8%) were non-dipper, with 56 being extreme non-dipper. Anemia (OR 4.5, p=0.001) and C-reactive protein >10 mg/l (OR 3.7, p<0.001) induced a higher risk of non-dipper profile. We had 78 cardiovascular deaths (23.0%). Independent predictive factors for cardiovascular death were male gender, calcium x phosphate>55 mg2/dl2 and extreme non-dipper.

Conclusion

This study demonstrates an increased prevalence of high BP readings and non-dipper profile especially in advanced CKD. Malnutrition and inflammation were associated with non-dipper pattern and extreme non-dipper was an independent risk factor for cardiovascular death. ABPM monitoring may be useful in optimizing BP control and improving cardiovascular outcome in CKD .