Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD

Francis B. Gabbai, Mahboob Rahman, Bo Hu, Lawrence J. Appel, Jeanne Charleston, Gabriel Contreras, Marquetta L. Faulkner, Leena Hiremath, Kenneth A. Jamerson, Janice P. Lea, Michael S. Lipkowitz, Velvie A. Pogue, Stephen G. Rostand, Miroslaw J. Smogorzewski, Jackson T. Wright, Tom Greene, Jennifer Gassman, Xuelei Wang, Robert A. Phillips

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background and objectives Abnormal ambulatory BP (ABP) profiles are commonplace in CKD, yet the prognostic value of ABP for renal and cardiovascular outcomes is uncertain. This study assessed the relationship of baseline ABP profiles with CKD progression and subsequent cardiovascular outcomes to determine the prognostic value of ABP beyond that of clinic BP measurements. Design, setting, participants, & measurements Between 2002 and 2003, 617 African Americans with hypertensive CKD treated to a clinic BP goal of <130/80 mmHg were enrolled in this prospective, observational study. Participants were followed for a median of 5 years. Primary renal outcome was a composite of doubling of serum creatinine, ESRD, or death. The primary cardiovascular outcome was a composite of myocardial infarction, hospitalized congestive heart failure, stroke, revascularization procedures, cardiovascular death, and ESRD. Results Multivariable Cox proportional hazard analysis showed that higher 24-hour systolic BP (SBP), daytime, night-time, and clinic SBP were each associated with subsequent renal (hazard ratio, 1.17-1.28; P<0.001) and cardiovascular outcomes (hazard ratio, 1.22-1.32; P<0.001). After controlling for clinic SBP, ABP measures were predictive of renal outcomes in participants with clinic SBP <130 mmHg (P<0.05 for interaction). ABP predicted cardiovascular outcomes with no interaction based on clinic BP control. Conclusions ABP provides additional information beyond that of multiple clinic BP measures in predicting renal and cardiovascular outcomes in African Americans with hypertensive CKD. The primary utility of ABP in these CKD patients was to identify high-risk individuals among those patients with controlled clinic BP.

Original languageEnglish
Pages (from-to)1770-1776
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume7
Issue number11
DOIs
StatePublished - Nov 7 2012
Externally publishedYes

Fingerprint

Kidney
African Americans
Chronic Kidney Failure
Observational Studies
Creatinine
Heart Failure
Stroke
Myocardial Infarction
Prospective Studies
Serum

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD. / Gabbai, Francis B.; Rahman, Mahboob; Hu, Bo; Appel, Lawrence J.; Charleston, Jeanne; Contreras, Gabriel; Faulkner, Marquetta L.; Hiremath, Leena; Jamerson, Kenneth A.; Lea, Janice P.; Lipkowitz, Michael S.; Pogue, Velvie A.; Rostand, Stephen G.; Smogorzewski, Miroslaw J.; Wright, Jackson T.; Greene, Tom; Gassman, Jennifer; Wang, Xuelei; Phillips, Robert A.

In: Clinical Journal of the American Society of Nephrology, Vol. 7, No. 11, 07.11.2012, p. 1770-1776.

Research output: Contribution to journalArticle

Gabbai, FB, Rahman, M, Hu, B, Appel, LJ, Charleston, J, Contreras, G, Faulkner, ML, Hiremath, L, Jamerson, KA, Lea, JP, Lipkowitz, MS, Pogue, VA, Rostand, SG, Smogorzewski, MJ, Wright, JT, Greene, T, Gassman, J, Wang, X & Phillips, RA 2012, 'Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD', Clinical Journal of the American Society of Nephrology, vol. 7, no. 11, pp. 1770-1776. https://doi.org/10.2215/CJN.11301111
Gabbai, Francis B. ; Rahman, Mahboob ; Hu, Bo ; Appel, Lawrence J. ; Charleston, Jeanne ; Contreras, Gabriel ; Faulkner, Marquetta L. ; Hiremath, Leena ; Jamerson, Kenneth A. ; Lea, Janice P. ; Lipkowitz, Michael S. ; Pogue, Velvie A. ; Rostand, Stephen G. ; Smogorzewski, Miroslaw J. ; Wright, Jackson T. ; Greene, Tom ; Gassman, Jennifer ; Wang, Xuelei ; Phillips, Robert A. / Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD. In: Clinical Journal of the American Society of Nephrology. 2012 ; Vol. 7, No. 11. pp. 1770-1776.
@article{c6a3ad8daa42438b86871e329aefcf65,
title = "Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD",
abstract = "Background and objectives Abnormal ambulatory BP (ABP) profiles are commonplace in CKD, yet the prognostic value of ABP for renal and cardiovascular outcomes is uncertain. This study assessed the relationship of baseline ABP profiles with CKD progression and subsequent cardiovascular outcomes to determine the prognostic value of ABP beyond that of clinic BP measurements. Design, setting, participants, & measurements Between 2002 and 2003, 617 African Americans with hypertensive CKD treated to a clinic BP goal of <130/80 mmHg were enrolled in this prospective, observational study. Participants were followed for a median of 5 years. Primary renal outcome was a composite of doubling of serum creatinine, ESRD, or death. The primary cardiovascular outcome was a composite of myocardial infarction, hospitalized congestive heart failure, stroke, revascularization procedures, cardiovascular death, and ESRD. Results Multivariable Cox proportional hazard analysis showed that higher 24-hour systolic BP (SBP), daytime, night-time, and clinic SBP were each associated with subsequent renal (hazard ratio, 1.17-1.28; P<0.001) and cardiovascular outcomes (hazard ratio, 1.22-1.32; P<0.001). After controlling for clinic SBP, ABP measures were predictive of renal outcomes in participants with clinic SBP <130 mmHg (P<0.05 for interaction). ABP predicted cardiovascular outcomes with no interaction based on clinic BP control. Conclusions ABP provides additional information beyond that of multiple clinic BP measures in predicting renal and cardiovascular outcomes in African Americans with hypertensive CKD. The primary utility of ABP in these CKD patients was to identify high-risk individuals among those patients with controlled clinic BP.",
author = "Gabbai, {Francis B.} and Mahboob Rahman and Bo Hu and Appel, {Lawrence J.} and Jeanne Charleston and Gabriel Contreras and Faulkner, {Marquetta L.} and Leena Hiremath and Jamerson, {Kenneth A.} and Lea, {Janice P.} and Lipkowitz, {Michael S.} and Pogue, {Velvie A.} and Rostand, {Stephen G.} and Smogorzewski, {Miroslaw J.} and Wright, {Jackson T.} and Tom Greene and Jennifer Gassman and Xuelei Wang and Phillips, {Robert A.}",
year = "2012",
month = "11",
day = "7",
doi = "10.2215/CJN.11301111",
language = "English",
volume = "7",
pages = "1770--1776",
journal = "Clinical journal of the American Society of Nephrology : CJASN",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "11",

}

TY - JOUR

T1 - Relationship between ambulatory BP and clinical outcomes in patients with hypertensive CKD

AU - Gabbai, Francis B.

AU - Rahman, Mahboob

AU - Hu, Bo

AU - Appel, Lawrence J.

AU - Charleston, Jeanne

AU - Contreras, Gabriel

AU - Faulkner, Marquetta L.

AU - Hiremath, Leena

AU - Jamerson, Kenneth A.

AU - Lea, Janice P.

AU - Lipkowitz, Michael S.

AU - Pogue, Velvie A.

AU - Rostand, Stephen G.

AU - Smogorzewski, Miroslaw J.

AU - Wright, Jackson T.

AU - Greene, Tom

AU - Gassman, Jennifer

AU - Wang, Xuelei

AU - Phillips, Robert A.

PY - 2012/11/7

Y1 - 2012/11/7

N2 - Background and objectives Abnormal ambulatory BP (ABP) profiles are commonplace in CKD, yet the prognostic value of ABP for renal and cardiovascular outcomes is uncertain. This study assessed the relationship of baseline ABP profiles with CKD progression and subsequent cardiovascular outcomes to determine the prognostic value of ABP beyond that of clinic BP measurements. Design, setting, participants, & measurements Between 2002 and 2003, 617 African Americans with hypertensive CKD treated to a clinic BP goal of <130/80 mmHg were enrolled in this prospective, observational study. Participants were followed for a median of 5 years. Primary renal outcome was a composite of doubling of serum creatinine, ESRD, or death. The primary cardiovascular outcome was a composite of myocardial infarction, hospitalized congestive heart failure, stroke, revascularization procedures, cardiovascular death, and ESRD. Results Multivariable Cox proportional hazard analysis showed that higher 24-hour systolic BP (SBP), daytime, night-time, and clinic SBP were each associated with subsequent renal (hazard ratio, 1.17-1.28; P<0.001) and cardiovascular outcomes (hazard ratio, 1.22-1.32; P<0.001). After controlling for clinic SBP, ABP measures were predictive of renal outcomes in participants with clinic SBP <130 mmHg (P<0.05 for interaction). ABP predicted cardiovascular outcomes with no interaction based on clinic BP control. Conclusions ABP provides additional information beyond that of multiple clinic BP measures in predicting renal and cardiovascular outcomes in African Americans with hypertensive CKD. The primary utility of ABP in these CKD patients was to identify high-risk individuals among those patients with controlled clinic BP.

AB - Background and objectives Abnormal ambulatory BP (ABP) profiles are commonplace in CKD, yet the prognostic value of ABP for renal and cardiovascular outcomes is uncertain. This study assessed the relationship of baseline ABP profiles with CKD progression and subsequent cardiovascular outcomes to determine the prognostic value of ABP beyond that of clinic BP measurements. Design, setting, participants, & measurements Between 2002 and 2003, 617 African Americans with hypertensive CKD treated to a clinic BP goal of <130/80 mmHg were enrolled in this prospective, observational study. Participants were followed for a median of 5 years. Primary renal outcome was a composite of doubling of serum creatinine, ESRD, or death. The primary cardiovascular outcome was a composite of myocardial infarction, hospitalized congestive heart failure, stroke, revascularization procedures, cardiovascular death, and ESRD. Results Multivariable Cox proportional hazard analysis showed that higher 24-hour systolic BP (SBP), daytime, night-time, and clinic SBP were each associated with subsequent renal (hazard ratio, 1.17-1.28; P<0.001) and cardiovascular outcomes (hazard ratio, 1.22-1.32; P<0.001). After controlling for clinic SBP, ABP measures were predictive of renal outcomes in participants with clinic SBP <130 mmHg (P<0.05 for interaction). ABP predicted cardiovascular outcomes with no interaction based on clinic BP control. Conclusions ABP provides additional information beyond that of multiple clinic BP measures in predicting renal and cardiovascular outcomes in African Americans with hypertensive CKD. The primary utility of ABP in these CKD patients was to identify high-risk individuals among those patients with controlled clinic BP.

UR - http://www.scopus.com/inward/record.url?scp=84869100452&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84869100452&partnerID=8YFLogxK

U2 - 10.2215/CJN.11301111

DO - 10.2215/CJN.11301111

M3 - Article

C2 - 22935847

AN - SCOPUS:84869100452

VL - 7

SP - 1770

EP - 1776

JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

SN - 1555-9041

IS - 11

ER -