OP.3A.06] PROGRESSIVE DISRUPTION OF AMBULATORY BLOOD PRESSURE REGULATION WITH SEVERITY STAGE OF CHRONIC KIDNEY DISEASE

Abstract

Objective: Sleep-time hypertension and the non-dipper blood pressure (BP) patterning determined by ambulatory BP monitoring (ABPM) are highly prevalent in chronic kidney disease (CKD), and both factors have been consistently associated with the elevated cardiovascular disease (CVD) risk of such patients. We have assessed the prevalence of these alterations in ambulatory BP regulation as a function of the severity stage of CKD among the participants of the Hygia Project, a research network presently composed of 292 investigators of 40 clinical sites, primarily designed, among other objectives, to evaluate the prognostic value of ABPM to predict CVD risk. Design and method: This cross-sectional investigation involved 7,452 patients with CKD (estimated glomerular filtration rate [eGFR] <60, albuminuria, or both, at least twice within 3 months), 4,325 men/3,127 women, 65.3 ± 13.8 years of age, with BP, according to ABPM criteria, ranging from normotension to sustained hypertension. Ambulatory BP was measured for 48 consecutive hours. Results: There was a highly significant (P < 0.001) progressive increase in the asleep systolic BP (SBP) mean with increasing severity of CKD. The awake SBP mean, however, did not changed consistently throughout the different stages of CKD. Accordingly, the sleep-time relative SBP decline was progressively and significantly (P < 0.001) attenuated towards a more non-dipper BP patterning with diminishing eGFR. Most important, the proportion of patients with the riser BP pattern (asleep SBP mean greater than awake SBP mean) significantly and progressively increased from 5.8% of the participants with stage-1-CKD to a very high 33.7% of the participants with stage-5-CKD. Conclusions: This study, the largest reported so far on CKD patients evaluated by highly-reproducible 48 h ABPM, documents the high prevalence of alteration in sleep-time BP regulation in this condition. Most important, prevalence of the riser BP pattern, associated with highest CVD risk, is also very high, from 20% in stage-3-CKD to 34% in end-stage-renal-disease. Collectively, these findings indicate ABPM should be mandatory for proper CVD risk stratification in CKD, as well as a means to establish the most adequate therapeutic scheme to properly control sleep-time BP and decrease CVD risk.