Visit-to-visit variability in blood pressure and kidney and cardiovascular outcomes in patients with type 2 diabetes and nephropathy: a post hoc analysis from the RENAAL study and the Irbesartan Diabetic Nephropathy Trial.

Abstract

BACKGROUND:

Increased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points. However, few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney disease outcomes. We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy.

STUDY DESIGN:

Observational analysis of IDNT (Irbesartan Diabetic Nephropathy Trial) and the RENAAL (Reduction of End Points in Non-Insulin-Dependent Diabetes With the Angiotensin II Antagonist Losartan) Study.

SETTING & PARTICIPANTS:

2,739 participants with type 2 diabetes and nephropathy with at least 1 year of blood pressure measurements available.

PREDICTORS:

Systolic blood pressure visit-to-visit variability was calculated from the SD of the systolic blood pressure from 4 visits occurring 3-12 months postrandomization.

OUTCOMES:

The kidney disease outcome was defined as time to confirmed doubling of serum creatinine level, end-stage renal disease, or death; the cardiovascular outcome was defined as time to cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, or revascularization.

RESULTS:

Mean visit-to-visit variability in systolic blood pressure from 3 to 12 months postrandomization was 12.0±6.8(SD)mmHg. Following this ascertainment period, there were 954 kidney disease and 542 cardiovascular events. Greater systolic blood pressure visit-to-visit variability was associated independently with increased risk of the composite kidney disease end point (HR per 1-SD increment, 1.08 [95%CI, 1.01-1.16]; P=0.02) and end-stage renal disease, but not with the cardiovascular outcome.

LIMITATIONS:

Observational study with the potential for confounding.

CONCLUSIONS:

In diabetic individuals with nephropathy, systolic blood pressure visit-to-visit variability is associated independently with hard kidney disease outcomes.

• Authors: Ciaran J McMullan, Hiddo J Lambers Heerspink, Hans-Henrik Parving, Jamie P Dwyer, John P Forman, Dick de Zeeuw
• Journal: American journal of kidney diseases : the official journal of the National Kidney Foundation (Am J Kidney Dis) Vol. 64 Issue 5 Pg. 714-22 (Nov 2014) ISSN: 1523-6838 [Electronic] United States
• PMID: 25064674 (Publication Type: Journal Article, Observational Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Chemical References

• Angiotensin II Type 1 Receptor Blockers
• Biphenyl Compounds
• Tetrazoles
• Irbesartan

Topics

• Aged
• Angiotensin II Type 1 Receptor Blockers (pharmacology, therapeutic use)
• Biphenyl Compounds (pharmacology, therapeutic use)
• Blood Pressure (drug effects, physiology)
• Cardiovascular Diseases (diagnosis, drug therapy, physiopathology)
• Cohort Studies
• Diabetes Mellitus, Type 2 (diagnosis, drug therapy, physiopathology)
• Diabetic Nephropathies (diagnosis, drug therapy, physiopathology)
• Double-Blind Method
• Female
• Follow-Up Studies
• Humans
• Irbesartan
• Kidney (drug effects, physiology)
• Male
• Middle Aged
• Office Visits (trends)
• Prospective Studies
• Tetrazoles (pharmacology, therapeutic use)
• Treatment Outcome