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Central blood pressure and cardiovascular outcomes in chronic kidney disease

Clinical Journal of the American Society of Nephrology Apr 21, 2018

Rahman M, et al. - In patients with CKD, researchers determined the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality, as well as the role of central BP measurement along with brachial BP in estimating cardiovascular risk. In this patient population, elevated brachial and central BP measurements were both found to be related to higher risk of cardiovascular disease outcomes. Relative to brachial BP measurement, central BP measurement did not improve the ability to predict cardiovascular disease outcomes or mortality in CKD patients.

Methods

  • Using the SphygmoCorPVx System, central BP was measured in this prospective, longitudinal study (the Chronic Renal Insufficiency Cohort).
  • Analyses were performed using Cox proportional hazards models.

Results

  • Participants (n=2,875) had a mean age of 60 years.
  • Higher risk for the composite cardiovascular outcome (hazard ratio, 1.59; 95% confidence interval, 1.17 to 2.17; c statistic, 0.76), but not all-cause mortality (hazard ratio, 1.28; 95% confidence interval, 0.90 to 1.80), was seen in participants in the highest quartile of brachial systolic BP (≥138 mm Hg) vs those in the lowest quartile, after a median follow-up of 5.5 years.
  • Participants in the highest quartile of central systolic BP vs participants in the lowest quartile were also at higher risk for the composite cardiovascular outcome (hazard ratio, 1.69; 95% confidence interval, 1.24 to 2.31; c statistic, 0.76).
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