Abstract
Objective: Visit-to-visit variability in systolic BP is recognized as an independent and strong predictors of cardiovascular event particularly stroke and coronary event. However the relationship between Visit-to-visit variability of blood pressure and renal function decline still controversial. This study aims to determine the association between BPV and CKD status in primary care setting. Design and method: This is a retrospective study of a cohort over a period of 10 years. Demographic factors, cardiovascular risk factors and use of antihypertensive agents were also captured. BPV in this study is estimated using standard deviation (SD) of the 3 office blood pressure reading at 1998, 2002 and 2007. SD is calculated as squared root of [sum(individual blood pressure readings-sample mean blood pressure)2] number of visit. The estimated glomerular filtration rate (eGFR) was used to determine renal function [20] and it was based on the Cockcroft-Gault formula as follows. Decline in eGFR was defined as the difference between 2007 and 1998 divided by 10 years. CKD was defined when the eGFR is < 60 ml/min/1.73 m2 Pearson correlation test was used to look for the association between BPV and declination in eGFR. Results: 1547 subjects were in original cohort, 91% (n = 1408) had complete BP readings for analysis. The mean age of the population was 56.4 ± 9.8 years and 66.2% (n = 932) were female. 49.9%(N = 702) of the patients have diabetes and 58.3% (N = 821) of them have hypertension. The BPV was 11.2 ± 6.6 mmHg among patient with CKD in 2007 compared to patients without CKD (10.6 ± 6.6). Using Pearson correlation, there was association between BPV and overall declination in eGFR (p = 0.02). Conclusions: The BPV seems to be able to predict the declination of eGFR in our study. Hence, in managing patients with chronic disease particularly hypertension, clinicians should treated patients more aggressively in order to reduce BPV variability in order to slow down the deterioration of renal function achieve blood pressure target and thus reduce cardiovascular events.
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