CoChat
Sign Up
Cited by 31Blood Pressure and Hypertension StudiesChronic Kidney Disease and DiabetesCardiovascular Health and Disease Prevention

Blood Pressure Variability and the Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis

Open access
Yang, Letian, Li, Jian, Wei, Wei, Pu, Yajun, Zhang, Ling, Cui, Tianlei, Ma, Liang, Wang, Bo +2 more·2023·Journal of General Internal Medicine
DOI 10.1007/s11606-022-08001-6PMC PMC10110830
Open this paper in CoChat — free accountOpen PDF

Abstract

Background Blood pressure variability (BPV) is a risk factor for poor prognosis including cardiovascular events, chronic kidney disease, and mortality, independent of elevated BP. Methods We searched PubMed/Medline, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 23, 2022. Cohort studies reporting the association between BPV and chronic kidney disease (CKD) progression were selected. Hazard ratios were pooled using a random-effects model. Meta-regression, subgroup analyses, and sensitivity analyses were conducted. Results A total of 23 studies were included in this systematic review and meta-analysis. Increased BPV was associated with progression of CKD (HR: 1.21, 95% CI: 1.09-1.33) and incidence of ESRD (HR: 1.08, 95% CI: 1.08-1.30). Among the different BPV metrics, high variation independent of mean (VIM), coefficient of variation (CV), standard deviation (SD), and average real variability (ARV) were indicated as predictors of CKD progression. Discussion Increased BPV was associated with CKD progression.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1007/s11606-022-08001-6

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Blood pressure variability was associated with 47% greater risk of kidney failure (HR 1.47; 95% CI 1.09-1.99) for each 10-mmHg increase after adjustment for demographic and traditional risk factors.

    “Blood pressure variability was associated with 47% greater risk of kidney failure (hazard ratio [HR] 1.47; 95% CI 1.09-1.99)for each 10-mmHg increase after adjustment for demographic and traditional risk factors (84,85).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [85]

    The ‘BPV and the Progression of CKD’ section reports an association between increased blood pressure variability and end-stage renal disease, but gives HR 1.18 (95% CI 1.08–1.30), not 1.47 (1.09–1.99). The cited paper does not establish the claimed estimate per 10-mmHg increase or specify that estimate as adjusted for demographic and traditional risk factors. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 58 · Cited by 31

Research works printed but not linked: 53

  1. Mancia G, Ferrari A, Gregorini L, Parati G, Pomidossi G, Bertinieri G, et al. Blood pressure and heart rate variabilities in normotensive and hypertensive human beings. Circ Res 1983;53(1):96-104. https://doi. org/10.1161/01.res.53.1.96 · DOI
  2. Frattola A, Parati G, Cuspidi C, Albini F, Mancia G. Prognostic value of 24-hour blood pressure variability. J Hypertens 1993;11(10):1133-7. https://doi.org/10.1097/00004872-199310000-00019 · DOI · Paper page
  3. Parati G, Pomidossi G, Albini F, Malaspina D, Mancia G. Relationship of 24-hour blood pressure mean and variability to severity of target-organ damage in hypertension. J Hypertens 1987;5(1):93-8. https://doi.org/ 10.1097/00004872-198702000-00013 · DOI · Paper page
  4. Tozawa M, Iseki K, Yoshi S, Fukiyama K. Blood pressure variability as an adverse prognostic risk factor in end-stage renal disease. Nephrol Dial Transplant 1999;14(8):1976-81.
  5. Timio M, Lolli S, Verdura C, Monarca C, Merante F, Guerrini E. Circadian blood pressure changes in patients with chronic renal insufficiency: a prospective study. Ren Fail 1993;15(2):231-7.
  6. Global, regional, and national burden of chronic kidney disease, 1990- 2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2020;395(10225):709-33. https://doi. org/10.1016/s0140-6736(20)30045-3 · DOI
  7. Di Iorio B, Pota A, Sirico ML, Torraca S, Di Micco L, Rubino R, et al. Blood pressure variability and outcomes in chronic kidney disease. Nephrology Dial Transplant 2012;27(12):4404-10. https://doi.org/10. 1093/ndt/gfs328 · DOI
  8. Ruiz-Ortega M, Rayego-Mateos S, Lamas S, Ortiz A, Rodrigues-Diez RR. Targeting the progression of chronic kidney disease. Nat Rev Nephrol 2020;16(5):269-88. https://doi.org/10.1038/s41581-019-0248-y · DOI · Paper page
  9. Li H, Xue J, Dai W, Chen Y, Zhou Q, Chen W. Visit-to-visit blood pressure variability and risk of chronic kidney disease: A systematic review and meta-analyses. PLoS One 2020;15(5):e0233233. https://doi. org/10.1371/journal.pone.0233233 · DOI
  10. Whittle J, Lynch AI, Tanner RM, Simpson LM, Davis BR, Rahman M, et al. Visit-to-Visit Variability of BP and CKD Outcomes: Results from the ALLHAT. Clin J Am Soc Nephrol: CJASN 2016;11(3):471-80. https://doi. org/10.2215/cjn.04660415 · DOI
  11. Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med 2013;158(4):280-6. https://doi.org/10.7326/0003-4819-158-4- 201302190-00009 · DOI · Paper page
  12. Isobe S, Ohashi N, Ishigaki S, Tsuji N, Tsuji T, Kato A, et al. Increased nocturnal blood pressure variability is associated with renal arteriolar hyalinosis in normotensive patients with IgA nephropathy. Hypertens Res 2017;40(11):921-6. https://doi.org/10.1038/hr.2017.66 · DOI
  13. Li Y, Li D, Song Y, Gao L, Fan F, Wang B, et al. Visit-to-visit variability in blood pressure and the development of chronic kidney disease in treated ge neral hypertensi ve patients. Nephrol Dial Transpla nt 2020;35(10):1739-46. https://doi.org/10.1093/ndt/gfz093 · DOI
  14. Ryu J, Cha RH, Kim DK, Lee JH, Yoon SA, Ryu DR, et al. The clinical association of the blood pressure variability with the target organ damage in hypertensive patients with chronic kidney disease. J Korean Med Sci 2014;29(7):957-64. https://doi.org/10.3346/jkms.2014.29.7.957 · DOI
  15. Nakano C, Morimoto S, Nakahigashi M, Kusabe M, Ueda H, Someya K, et al. The relationships between visit-to-visit blood pressure variability and renal and endothelial function in chronic kidney disease. Hypertens Res 2015;38(3):193-8. https://doi.org/10.1038/hr.2014.163 · DOI
  16. Sarafidis PA, Ruilope LM, Loutradis C, Gorostidi M, de la Sierra A, de la Cruz JJ, et al. Blood pressure variability increases with advancing chronic kidney disease stage: a cross-sectional analysis of 16 546 hypertensive patients. J Hypertens 2018;36(5):1076-85. https://doi. org/10.1097/HJH.0000000000001670 · DOI
  17. Okada T, Nakao T, Matsumoto H, Nagaoka Y, Tomaru R, Iwasawa H, et al. [Day-by-day variability of home blood pressure in patients with chronic kidney disease]. Nihon Jinzo Gakkai shi 2008;50(5):588-96.
  18. Sethna CB, Meyers KEC, Mariani LH, Psoter KJ, Gadegbeku CA, Gibson KL, et al. Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopa- thies. Hypertension (Dallas, Tex.: 1979). 2017;70(2):315-23. https://doi. org/10.1161/hypertensionaha.117.09475 · DOI
  19. Tang C, Zhang XY, Lv JC, Shi SF, Zhou XJ, Liu LJ, et al. Visit-to-visit variability in blood pressure and kidney disease progression in IgA nephropathy. Clin Kidney J 2022;15(12):2331-9. https://doi.org/10. 1093/ckj/sfac200 · DOI
  20. Wang G, Ma K, Ma Z, Guo X, Wang Y, Ma L, et al. Short-term blood pressure variability and outcomes in non-dialysis chronic kidney disease. Front Med 2022;9:911205. https://doi.org/10.3389/fmed.2022.911205 · DOI
  21. Bae EH, Lim SY, Han KD, Oh TR, Choi HS, Kim CS, et al. Association Between Systolic and Diastolic Blood Pressure Variability and the Risk of End-Stage Renal Disease. Hypertension (Dallas, Tex.: 1979). 2019;74(4):880-7. https://doi.org/10.1161/hypertensionaha.119.13422 · DOI
  22. Borrelli S, Garofalo C, Mallamaci F, Tripepi G, Stanzione G, Provenzano M, et al. Short-term blood pressure variability in nondialysis chronic kidney disease patients: correlates and prognostic role on the progression of renal disease. J Hypertens 2018;36(12):2398- 405. https://doi.org/10.1097/hjh.0000000000001825 · DOI
  23. Chang TI, Tabada GH, Yang J, Tan TC, Go AS. Visit-to-visit variability of blood pressure and death, end-stage renal disease, and cardiovascular events in patients with chronic kidney disease. J Hypertens 2016;34(2):244-52. https://doi.org/10.1097/hjh.0000000000000779 · DOI
  24. Gregg LP, Hedayati SS, Yang H, Van Buren PN, Banerjee S, Navaneethan SD, et al. Association of Blood Pressure Variability and Diuretics With Cardiovascular Events in Patients With Chronic Kidney Disease Stages 1-5. Hypertension (Dallas, Tex.: 1979). 2021;77(3): 948- 959. https://doi.org/10.1161/HYPERTENSIONAHA.120.16117 · DOI
  25. Jhee JH, Seo J, Lee CJ, Park JT, Han SH, Kang SW, et al. Ambulatory blood pressure variability and risk of cardiovascular events, all-cause mortality, and progression of kidney disease. J Hypertens 2020;38(9):1712-21. https://doi.org/10.1097/hjh.0000000000002477 · DOI
  26. McMullan CJ, Bakris GL, Phillips RA, Forman JP. Association of BP variability with mortality among African Americans with CKD. Clin J Am Soc Nephrol: CJASN 2013;8(5):731-8. https://doi.org/10.2215/CJN. 10131012 · DOI
  27. Okada T, Matsumoto H, Nagaoka Y, Nakao T. Association of home blood pressure variability with progression of chronic kidney disease. Blood Press Monit 2012;17(1):1-7. https://doi.org/10.1097/MBP. 0b013e32834f7125 · DOI
  28. Pallikadavath S, Chambers L, Shepherd D, Sukhnani M, Medcalf JF, Gray LJ, et al. The association of blood pressure variability with adverse outcomes in a primary care chronic kidney disease cohort. J Hypertens 2021;39(10):2067-74. https://doi.org/10.1097/hjh.0000000000002893 · DOI
  29. Sahutoglu T, Sakaci T. Diastolic blood pressure variability in 24 hour- ABPM and outcomes of chronic kidney disease. Clin Nephrol 2018;90(1):46-52. https://doi.org/10.5414/cn109311 · DOI
  30. Takao T, Matsuyama Y, Yanagisawa H, Kikuchi M, Kawazu S. Visit-to- visit variability in systolic blood pressure predicts development and progression of diabetic nephropathy, but not retinopathy, in patients with type 2 diabetes. J Diabetes Complicat 2014;28(2):185-90. https:// doi.org/10.1016/j.jdiacomp.2013.11.003 · DOI
  31. Yokota K, Fukuda M, Matsui Y, Hoshide S, Shimada K, Kario K. Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney disease. Hypertens Res 2013;36(2):151-7. https://doi.org/10.1038/hr.2012. 145 · DOI
  32. Fujita H, Matsuoka S, Awazu M. Visit-to-visit blood pressure variability in children and adolescents with renal disease. Clin Exp Nephrol 2018;22(5):1150-6. https://doi.org/10.1007/s10157-018-1557-3 · DOI
  33. Mancia G, Parati G, Hennig M, Flatau B, Omboni S, Glavina F, et al. Relation between blood pressure variability and carotid artery damage in hypertension: baseline data from the European Lacidipine Study on Atherosclerosis (ELSA). J Hypertens 2001;19(11):1981-9. https://doi. org/10.1097/00004872-200111000-00008 · DOI · Paper page
  34. Masugata H, Senda S, Murao K, Inukai M, Hosomi N, Iwado Y, et al. Visit-to-visit variability in blood pressure over a 1-year period is a marker of left ventricular diastolic dysfunction in treated hypertensive patients. Hypertens Res 2011;34(7):846-50. https://doi.org/10.1038/hr.2011.54 · DOI
  35. Mehlum MH, Liestøl K, Kjeldsen SE, Julius S, Hua TA, Rothwell PM, et al. Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks. Eur Heart J 2018;39(24):2243-51. https://doi.org/10.1093/eurheartj/ ehx760 · DOI · Paper page
  36. Stevens SL, Wood S, Koshiaris C, Law K, Glasziou P, Stevens RJ, et al. Blood pressure variability and cardiovascular disease: systematic review and meta-analysis. BMJ (Clin Res Ed.). 2016;354:i4098. https:// doi.org/10.1136/bmj.i4098 · DOI · Paper page
  37. Miao CY, Xie HH, Zhan LS, Su DF. Blood pressure variability is more important than blood pressure level in determination of end-organ damage in rats. J Hypertens 2006;24(6):1125-35. https://doi.org/10. 1097/01.hjh.0000226203.57818.88 · DOI
  38. Kilpatrick ES, Rigby AS, Atkin SL. The role of blood pressure variability in the development of nephropathy in type 1 diabetes. Diabetes Care 2010;33(11):2442-7. https://doi.org/10.2337/dc10-1000 · DOI
  39. Tsai WC, Wu HY, Peng YS, Ko MJ, Wu MS, Hung KY, et al. Risk Factors for Development and Progression of Chronic Kidney Disease: A System- a t i c R e v i e w a n d E x p l o r a t o r y M e t a -A n a l y s i s . M e d i c i n e . 2016;95(11):e3013. https://doi.org/10.1097/md.0000000000003013 · DOI
  40. Chang AR, Lóser M, Malhotra R, Appel LJ. Blood Pressure Goals in Patients with CKD: A Review of Evidence and Guidelines. Clin J Am Soc Nephrol: CJASN 2019;14(1):161-9. https://doi.org/10.2215/cjn. 07440618 · DOI
  41. Townsend RR. Arterial Stiffness in CKD: A Review. Am J Kidney Dis 2019;73(2):240-7. https://doi.org/10.1053/j.ajkd.2018.04.005 · DOI
  42. Nowak KL, Chonchol M, Jovanovich A, You Z, Ambrosius WT, Cho ME, et al. Arterial stiffness and kidney disease progression in the systolic blood pressure intervention trial. Clin Nephrol. 2020;94(1):26-35. https://doi.org/10.5414/cn109982 · DOI
  43. Azukaitis K, Jankauskiene A, Schaefer F, Shroff R. Pathophysiology and consequences of arterial stiffness in children with chronic kidney disease. Pediatr Nephrol (Berlin, Germany). 2021;36(7):1683-95. https:// doi.org/10.1007/s00467-020-04732-y · DOI
  44. Weir MR, Lakkis JI, Jaar B, Rocco MV, Choi MJ, Kramer HJ, et al. Use of Renin-Angiotensin System Blockade in Advanced CKD: An NKF- KDOQI Controversies Report. Am J Kidney Dis 2018;72(6):873-84. https://doi.org/10.1053/j.ajkd.2018.06.010 · DOI
  45. Xie X, Liu Y, Perkovic V, Li X, Ninomiya T, Hou W, et al. Renin- Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients With CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials. Am J Kidney Dis 2016;67(5):728-41. https://doi.org/10. 1053/j.ajkd.2015.10.011 · DOI
  46. Augustyniak RA, Picken MM, Leonard D, Zhou XJ, Zhang W, Victor RG. Sympathetic nerves and the progression of chronic kidney disease during 5/6 nephrectomy: studies in sympathectomized rats. Clin Exp Pharmacol Physiol 2010;37(1):12-8. https://doi.org/10.1111/j.1440- 1681.2009.05253.x · DOI
  47. Kobuchi S, Tanaka R, Funai A, Suzuki R, Yazawa M, Tsutsui H, et al. Involvement of renal sympathetic nerve overactivation in the progression of chronic kidney disease in rats. J Cardiovasc Pharmacol 2014;63(1):9- 15. https://doi.org/10.1097/fjc.0000000000000016 · DOI
  48. Paterno JC, Bergamaschi CT, Campos RR, Higa EM, Soares MF, Schor N, et al. Electroacupuncture and moxibustion decrease renal sympathetic nerve activity and retard progression of renal disease in rats. Kidney Blood Press Res 2012;35(5):355-64. https://doi.org/10.1159/ 000336095 · DOI
  49. Billings FTt, Shaw AD. Clinical trial endpoints in acute kidney injury. Nephron Clin Pract 2014;127(1-4):89-93. https://doi.org/10.1159/ 000363725 · DOI
  50. Zuk A, Palevsky PM, Fried L, Harrell FE, Khan S, McKay DB, et al. Overcoming Translational Barriers in Acute Kidney Injury: A Report from an NIDDK Workshop. Clin J Am Soc Nephrol: CJASN 2018;13(7):1113- 23. https://doi.org/10.2215/cjn.06820617 · DOI
  51. Parati G, Ochoa JE, Bilo G. Blood pressure variability, cardiovascular risk, and risk for renal disease progression. Curr Hypertens Rep 2012;14(5):421-31. https://doi.org/10.1007/s11906-012-0290-7 · DOI
  52. Ku E, Johansen KL, McCulloch CE. Time-Centered Approach to Understanding Risk Factors for the Progression of CKD. Clin J Am Soc Nephrol: CJASN 2018;13(5):693-701. https://doi.org/10.2215/cjn. 10360917 · DOI
  53. Ying T, Clayton P, Naresh C, Chadban S. Predictive value of spot versus 24-hour measures of proteinuria for death, end-stage kidney disease or chronic kidney disease progression. BMC Nephrol 2018;19(1):55. https://doi.org/10.1186/s12882-018-0853-1 · DOI

Authors
Yang, L., Li, J., Wei, W., Pu, Y., Zhang, L., Cui, T., Ma, L., Wang, B., Zhao, Y., & Fu, P.
Affiliations
  • West China Hospital of Sichuan University (CN)
  • Sichuan University (CN)
  • West China Medical Center of Sichuan University (CN)
Corresponding author
Zhao, Yuliang
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2023-01-17
Volume
38
Issue
5
Pages
1272-1281
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-022-08001-6
PMC
PMC10110830
OpenAlex
W4316881879
Cited by
31
References
58
Citations by year
2026: 10 · 2025: 13 · 2024: 5 · 2023: 3
FWCI
1.64
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Science and Technology Department of Sichuan Province (2021YJ0423)
  • West China Hospital, Sichuan University (2020HXFH014)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
blood pressure variability, chronic kidney disease progression, end-stage renal disease, cardiovascular risk factors, coefficient of variation, average real variability
MeSH terms
Blood Pressure, Humans, Kidney Failure, Chronic, Risk Factors, Cohort Studies, Disease Progression, Blood Pressure Monitoring, Ambulatory, Renal Insufficiency, Chronic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review