Abstract P112: Orthostatic Hypotension, Orthostatic Hypertension And Ambulatory Blood Pressure In Patients With Chronic Kidney Disease: Findings From The Chronic Renal Insufficiency Cohort Study

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Jordana Cohen ◽  
Raymond R Townsend ◽  
Paul Drawz ◽  
Mahboob Rahman ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Orthostatic Hypotension ◽  
Standing Position ◽  
White Coat ◽  
White Coat Effect ◽  
Orthostatic Hypertension ◽  
The Difference

Background: We recently demonstrated how orthostatic hypotension might be used to identify out-of-office blood pressure phenotypes, including white coat effects and nocturnal non-dipping patterns. However, these findings have not been replicated in a population with chronic kidney disease (CKD). Objective: To examine the association between orthostatic hypotension (OH) or hypertension (OHTN) with ambulatory BP in adults with CKD. Methods: CRIC is a prospective multicenter observation cohort study of participants with CKD. Standing BP at 1 minute and ABPM were obtained on 1467 participants. OH was defined as a 20mmHg drop in systolic BP (SBP) or 10 mmHg drop in diastolic BP (DBP) when changing from seated to standing positions. OHTN was defined as a 20 mmHg or 10mmHg rise in SBP or DBP respectively when changing from seated to standing position. White coat effects, based on ABPM, was defined as the difference between seated clinic and ambulatory BP. Systolic and diastolic night to day ratio was also calculated. Results: Of the 1467 participants (age: 58 ± 10 yrs, 44% female, 39% black) 73 had OH and 165 had OHTN). OH was positively associated with systolic and diastolic white coat effect (β=5.9 [0.9, 10.9] and 4.2 [1.3, 7.1]). OHTN was negatively associated with diastolic white coat effect (-4.9 [-6.9, -3]). OH was positively associated with systolic and diastolic night-to-day ratio (0.03 [0.01, 0.05] and 0.03 [0.01, 0.06] respectively). Conclusions: Clinic-based assessments of OH and OHTN may be useful for identifying BP phenotypes often missed with seated office BP measurements in CKD patients.

scholarly journals Prevalence and clinical correlates of white coat effect in patients with chronic kidney disease and the role of automated blood pressure device in its assessment

2018 ◽  
Vol 28 (6) ◽  
pp. 448
Author(s):  
ShankarPrasad Nagaraju ◽  
Srinivas Shenoy ◽  
NileshwarR Rau ◽  
RavindraA Prabhu ◽  
UdayVenkat Mateti ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
White Coat ◽  
Clinical Correlates ◽  
White Coat Effect ◽  
Blood Pressure Device

scholarly journals The Copenhagen chronic kidney disease echo study (COInCYDE)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Landler ◽  
S Bro ◽  
B Feldt-Rasmussen ◽  
D Hansen ◽  
A.L Kamper ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Cardiac Function ◽  
Left Ventricular ◽  
Funding Source ◽  
Ckd Stage ◽  
Significant Difference ◽  
Stage 1

Abstract Background The cardiovascular mortality of patients with chronic kidney disease (CKD) is 2–10 times higher than in the average population. Purpose To estimate the prevalence of abnormal cardiac function or structure across the stages CKD 1 to 5nonD. Method Prospective cohort study. Patients with CKD stage 1 to 5 not on dialysis, aged 30 to 75 (n=875) and age-/sex-matched controls (n=173) were enrolled consecutively. All participants underwent a health questionnaire, ECG, morphometric and blood pressure measurements. Blood and urine were analyzed. Echocardiography was performed. Left ventricle (LV) hypertrophy, dilatation, diastolic and systolic dysfunction were defined according to current ESC guidelines. Results 63% of participants were men. Mean age was 58 years (SD 12.6 years). Mean eGFR was 46.7 mL/min/1,73 m (SD 25.8) for patients and 82.3 mL/min/1,73 m (SD 13.4) for controls. The prevalence of elevated blood pressure at physical exam was 89% in patients vs. 53% in controls. Patients were more often smokers and obese. Left ventricular mass index (LVMI) was slightly, albeit insignificantly elevated at CKD stages 1 & 2 vs. in kontrols: 3.1 g/m2, CI: −0.4 to 6.75, p-value 0.08. There was no significant difference in LV-dilatation between patients and controls. Decreasing diastolic and systolic function was observed at CKD stage 3a and later: LVEF decreased 0.95% (CI: −1.5 to −0.2), GLS increased 0.5 (CI: 0.3 to 0.8), and OR for diastolic dysfunction increased 3.2 (CI 1.4 to 7.3) pr. increment CKD stage group. Conclusion In accordance to previous studies, we observe in the CPHCKD cohort study signs of early increase of LVMI in patients with CKD stage 1 & 2. Significant decline in systolic and diastolic cardiac function is apparent already at stage 3 CKD. Figure 1. Estimated GFR vs. GLS & histogram of GLS Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): The Capital Region of Denmark

Association Between Longitudinal Blood Pressure Trajectory and the Progression of Chronic Kidney Disease: Results From the KNOW-CKD

Hypertension ◽  
2021 ◽  
Author(s):  
Young Su Joo ◽  
Hyung Woo Kim ◽  
Ki Heon Nam ◽  
Jee Young Lee ◽  
Tae Ik Chang ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Latent Class ◽  
Mixed Model ◽  
Hazards Model ◽  
Trajectory Group ◽  
End Stage

Studies on the longitudinal temporal trend of blood pressure (BP) and its impact on kidney function are scarce. Here, we evaluated the association of dynamic changes in systolic blood pressure (SBP) over time with adverse kidney outcomes. We analyzed 1837 participants from the KNOW-CKD (Korean Cohort Study for Outcomes in Patients With Chronic Kidney Disease). The main exposure was 3 distinct SBP trajectories determined by the latent class mixed model (decreasing, stable, and increasing) using 3 SBP measurements at 0, 6, and 12 months. The primary outcome was CKD progression, defined as a composite of halving estimated glomerular filtration rate from baseline value or onset of end-stage kidney disease. SBP declined from 144 to 120 mm Hg in the decreasing SBP trajectory group and rose from 114 to 136 mm Hg in the increasing trajectory group within 1 year. During 6576 person-years of follow-up (median, 3.7 years), the composite outcome occurred in 521 (28.4%) participants. There were fewer primary outcome events in the decreasing (30.6%) and stable (26.5%) SBP trajectory groups than in the increasing trajectory group (33.0%). In the multivariable-adjusted cause-specific hazards model, increasing SBP trajectory was associated with a 1.28-fold higher risk for adverse kidney outcome compared with stable SBP trajectory. However, the risk for the primary outcome did not differ between the decreasing and stable SBP trajectory groups. In this longitudinal CKD cohort study, compared with stable SBP trajectory, increasing SBP trajectory was associated with higher risk for adverse kidney outcome, whereas decreasing SBP trajectory showed similar risk.

Limitations of the difference between clinic and daytime blood pressure as a surrogate measure of the ‘white-coat’ effect

1998 ◽  
Vol 16 (1) ◽  
pp. 23-29 ◽  
Author(s):  
Gianfranco Parati ◽  
Stefano Omboni ◽  
Jan Staessen ◽  
Lutgarde Thijs ◽  
Robert Fagard ◽  
...  
Keyword(s):  
Blood Pressure ◽  
White Coat ◽  
White Coat Effect ◽  
Daytime Blood Pressure ◽  
Surrogate Measure ◽  
The Difference

Abstract P172: Orthostatic Hypotension And 24-hr Ambulatory Blood Pressure Monitoring In The Sprint Trial

Hypertension ◽  
2020 ◽  
Vol 76 (Suppl_1) ◽  
Author(s):  
Lama Ghazi ◽  
Paul Drawz ◽  
Nicholas Pajewski ◽  
Stephen P Juraschek
Keyword(s):  
Blood Pressure ◽  
Orthostatic Hypotension ◽  
Blood Pressure Monitoring ◽  
Treatment Strategies ◽  
White Coat ◽  
Clinic Blood Pressure ◽  
Pressure Monitoring ◽  
Ambulatory Bp Monitoring ◽  
Trial Testing ◽  
The Difference

Background: Clinic blood pressure (BP) is measured in the seated position, which can miss important home BP phenotypes such as low ambulatory BP (white coat effects) or high supine BP (nocturnal non-dippers). Orthostatic hypotension (OH) is determined based on BP measurements in both seated (or supine) and standing positions, and thus could theoretically identify these important phenotypes in clinic. Objective: To determine the association of OH with white coat effects or night-to-daytime systolic BP (SBP) Methods: SPRINT was a randomized trial testing the effects of intensive (<120 mmHg) or standard (<140 mmHg) SBP treatment strategies in adults at higher risk of cardiovascular disease. OH was assessed at 6, 12, or 24-mths and defined as a decrease in standing and mean seated SBP ≥20 or DBP ≥10 mmHg after 1 min of standing. White coat effects, based on 24-hr ambulatory BP monitoring performed at the 27-mth visit (every 30-minutes), were defined as the difference between 27-mth seated clinic and ambulatory BP ≥ 20/≥10 mmHg. SBP dipping ratio was defined as the ratio of night-to-daytime SBP >0.9. Results: Of 897 adults (mean age 71.5 [SD, 9.5] yrs, 28.7% female, 28.0% black), 128 had OH at least once. Among those with OH, 14.8% had white coat effects versus 7.2% among those without OH. Moreover, 68.8% of those with OH demonstrated non-dipping patterns versus only 52.0% of those without OH. OH was positively associated with both white coat effects (OR=2.24; 95% CI: 1.28, 4.27) and higher night-to-daytime SBP (β=0.04; 95% CI: 0.02, 0.06) ( Table ). Conclusions: Clinic-based assessments of OH may be a useful tool for identifying BP phenotypes often missed with traditional seated BP assessments.

Sign in / Sign up

Export Citation Format

Share Document