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Abstract: PO2085

Associations of Blood Pressure Variability with Cardiovascular Events, Death, and ESKD in Patients with CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Gregg, L Parker, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Hedayati, Susan, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Yang, Hui, Texas Tech University Health Sciences Center School of Pharmacy, Dallas, TX, US, Dallas, Texas, United States
  • Van Buren, Peter N., University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Virani, Salim S., Baylor College of Medicine, Houston, Texas, United States
  • Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
  • Alvarez, Carlos A., Texas Tech University Health Sciences Center School of Pharmacy, Dallas, TX, US, Dallas, Texas, United States
Background

Visit-to-visit blood pressure variability (BPV) is associated with cardiovascular (CV) events in individuals with chronic kidney disease (CKD) stages 3-5. We examined the associations of BPV with CV events, death, and end-stage kidney disease (ESKD) among veterans with CKD stages 1-5 and hypertension, and if treatment with a thiazide or loop diuretic modified these associations.

Methods

In a matched cohort study, patients seen between 2010-2016 with non-dialysis CKD and hypertension on single-agent therapy with a non-diuretic were propensity matched 1:1 for initiation of a loop or thiazide diuretic vs. other antihypertensive class as their second agent. BPV, defined as the coefficient of variation of outpatient systolic blood pressure over 6 months after prescription of the second antihypertensive, was divided into quintiles. Cox proportional hazards regression measured associations of BPV with time to CV events (first among myocardial infarction [MI], hospitalization for heart failure, or ischemic stroke), each component of the primary outcome, all-cause death, and ESKD.

Results

We included 31,394 new users of diuretics and 31,394 patients initiating other agents. Over a median (IQR) follow up time of 939 (404-1,606) days, there were 7,326 CV events, 16,567 deaths, and 2,029 ESKD events. Higher BPV was associated with composite CV events (Figure). Diuretic exposure attenuated these associations at the fourth and fifth quintiles of BPV (interaction P=.03 at the 4th and .04 at the 5th quintile). BPV was also associated with MI, heart failure, stroke, and death, but not with ESKD (Figure). Diuretic treatment did not modify these associations.

Conclusion

BPV was associated with CV events and all-cause death but not ESKD in patients with CKD and hypertension. Diuretic use attenuated the association of BPV with CV events at the highest quintiles of BPV. Future studies should test whether diuretics improve CV outcomes in those with high BPV.

Funding

  • Private Foundation Support