Abstract
The “reverse dipping” blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a “dipper”, “non-dipper” and “reverse dippers” was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis.
Highlights
Ambulatory blood pressure monitoring (ABPM) is a better predictor of target-organ damage and cardiovascular events than clinical monitoring of BP6–9
A reverse dipping BP pattern was associated with an increased risk of total mortality, cardiovascular mortality, renal events and all cardiovascular events even when adjusted by 24-h systolic blood pressure (SBP), but the significant association between a non-dipping BP pattern and prognosis disappeared after adjustment by 24-h SBP
These results suggest that a reverse dipping BP pattern, rather than a non-dipping BP pattern, independent of 24-h SBP, is a risk factor for the prognosis in Chinese chronic kidney disease (CKD) patients not undergoing dialysis
Summary
Ambulatory blood pressure monitoring (ABPM) is a better predictor of target-organ damage and cardiovascular events than clinical monitoring of BP6–9. One study demonstrated that 80% of participants with hypertensive kidney disease had a non-dipping (41%) or reverse dipping (39%) BP profile, and that non-dippers and reverse dippers had more severe damage to target organs (proteinuria and left-ventricular hypertrophy) compared with patients with a normal BP pattern[13]. Data on the prognostic role of a reverse dipping BP pattern on all-cause and cardiac mortality in CKD patients not undergoing dialysis are scarce. One study from Italy suggested that CKD patients not undergoing dialysis with a reverse dipping BP pattern carried a greater risk of renal disease and CVD7. Studies on the effect of a reverse dipping BP pattern on the prognosis of Chinese CKD patients not undergoing dialysis are lacking. Long-term effects of a reverse dipping BP pattern on the prognosis of these patients were assessed
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