Association between 24-hour blood pressure variability and chronic kidney disease: A cross-sectional analysis of African Americans participating in the Jackson heart study Epidemiology and Health Outcomes

Abstract

Background: Studies suggest 24-h blood pressure (BP) variability has prognostic value for cardiovascular disease. Several factors associated with high 24-h BP variability are also common among individuals with chronic kidney disease (CKD). We hypothesized 24-h BP variability would be higher for individuals with versus without CKD. Methods: We analyzed 1,022 Jackson Heart Study participants who underwent ambulatory blood pressure monitoring (ABPM). Twenty-four hour BP variability was defined by two metrics: day-night standard deviation (SDdn) and average real variability (ARV). CKD was defined as ACR ≥30 mg/g or eGFR <60 mL/min/1.73 m2. Results: The mean SDdn of systolic BP (SBP) was 10.2∈±∈0.2 and 9.1∈±∈0.1 mmHg and the mean ARV of SBP was 9.2∈±∈0.2 and 8.6∈±∈0.1 mmHg for those with and without CKD, respectively (each p∈≤0.001). After adjustment for age and sex, SD;bsubesub & and ARV were 0.98 mmHg (95 % CI 0.59, 1.38) and 0.52 mmHg (95 % CI 0.18, 0.86), respectively, higher among participants with versus without CKD. These differences were not statistically significant after further multivariable adjustment including 24-h mean SBP. Older age, and higher total cholesterol and 24-h mean SBP were associated with higher SD;bsubesub& and ARV of SBP among participants with CKD. Mean SD;bsubesub & and ARV of diastolic BP (DBP) were higher for participants with versus without CKD but these associations were not present after multivariable adjustment. Conclusion: Data from the current study suggest that CKD is associated with higher 24-h BP variability, but the association is primarily explained by higher mean BP among those with CKD.