Correlates of Systolic Hypertension in Patients With Chronic Kidney Disease
Open accessAbstract
Hypertension in patients with chronic kidney disease (CKD) is predominantly systolic. The contribution of risk factors for hypertension to the overall systolic blood pressure (BP) is unknown. To study the relationship between risk factors for hypertension and systolic BP in patients with CKD, 232 veterans (mean age 67 years; 96% men; 20% black; 39% with diabetes mellitus; estimated glomerular filtration rate [GFR] 48 mL/min per 1.73 m 2 ) had clinic (routine and standardized measurements) and out-of-clinic (home and 24-hour ambulatory) BPs recorded. In multivariate analysis, using 17 risk factors, the log of the urine protein/creatinine ratio was the strongest predictor of systolic BP regardless of the BP measurement technique. The strength of the relationship between proteinuria and systolic BP was in the order ambulatory > home > standardized clinic > routine clinic BP measurement. Other independent predictors were age, race, and number of antihypertensive drugs used, and the model fit was better for out-of-clinic than clinic BP recordings. Estimated GFR was not an independent predictor of systolic BP by any technique. Nocturnal dipping was associated with higher estimated GFR, higher serum albumin, younger age, and less proteinuria. Proteinuria is the most important correlate of systolic BP in older men, the strongest relationship of which was with ambulatory and home systolic BP. Out-of-clinic BP recordings correlate better with target organ damage, as measured by proteinuria, and may be of greater clinical value than clinic BP recordings in predicting hypertension-related outcomes such as end-stage renal disease and death.
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The ADVANCED-J study in diabetic patients and the J-HOP study showed that home blood pressure was more closely associated with urinary albumin-creatinine excretion ratio than office blood pressure.
“the ADVANCED-J study in diabetic patients and the J-HOP study showed that HBP was more closely associated with urinary albumin--creatinine excretion ratio (UACR) than OBP [27,33].”
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Time points for obtaining representative values of 24-hour blood pressure in chronic kidney disease
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Self-citationCaring for individuals with hypertension in CKD, especially those with low education
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Self-citation
- Authors
- Agarwal, R., & Andersen, M. J.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- ORCID
- Agarwal, Rajiv
- Venue
- Hypertension
- Published
- 2005-09
- Volume
- 46
- Issue
- 3
- Pages
- 514-520
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- OpenAlex
- W2122393326
- Cited by
- 133
- References
- 29
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 5 · 2016: 9 · 2015: 11 · 2014: 6 · 2013: 7 · 2012: 5
- FWCI
- 5.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5t32dk062711-02)
- National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK062711-02)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Nursing › Nutrition and Dietetics › Sodium Intake and Health
- Keywords
- systolic hypertension, chronic kidney disease, proteinuria, urine protein-to-creatinine ratio, ambulatory blood pressure monitoring, home blood pressure monitoring, estimated glomerular filtration rate, nocturnal blood pressure dipping, veterans, diabetes mellitus, antihypertensive drugs, target organ damage
- MeSH terms
- Aged, Antihypertensive Agents, Blood Pressure, Blood Pressure Determination, Chronic Disease, Cross-Sectional Studies, Female, Renal Dialysis, Humans, Hypertension, Kidney Diseases, Kidney Failure, Chronic, Male, Proteinuria, Risk Factors, Sleep, Multivariate Analysis
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