Twenty-four-hour systolic blood pressure variability and renal function decline in elderly male hypertensive patients with well-controlled blood pressure

Clinical Interventions in Aging Dovepress open access to scientific and medical research Original Research Clinical Interventions in Aging downloaded from https://www.dovepress.com/ by 88.198.20.149 on 03-Oct-2019 For personal use only. Open Access Full Text Article Twenty-four-hour systolic blood pressure variability and renal function decline in elderly male hypertensive patients with well-controlled blood pressure This article was published in the following Dove Press journal: Clinical Interventions in Aging Xi Wang Fan Wang Minzhi Chen Xiaona Wang Jin Zheng Aimei Qin Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China Purpose: Increased variability in blood pressure (BP) is known to be closely associated with the development, progression and severity of renal damage in patients with chronic kidney disease. However, little is known about the association of BP variability (BPV) with the decline of renal function in elderly hypertensive patients with well-controlled BP. We, therefore, aimed to investigate the association between BPV and glomerular filtration rate in hypertensive elderly (age 60 years) and very elderly (age 80 years) male patients with BP controlled within the normal range by antihypertensive therapy. Patients and methods: This study involved 484 hospitalized elderly male hypertensive patients with BP controlled within the normal range by antihypertensive therapy. BPV was defined as the SD from mean BP over a 24 h period. Renal function was estimated by estimated glomerular filtration rate (eGFR) which was calculated by the Chinese modified Modification of Diet in Renal Disease Equation. Participants were divided into three groups according to their eGFR data. Multivariate linear regression was then used to analyze the correlation between eGFR and BPV. Results: The 24 h systolic BP (SBP) variability increased as eGFR decreased. There was no significant difference in 24 h SBP variability when compared between elderly and very elderly hypertensive patients. Multivariate linear regression analysis showed that SBP variability demonstrated a negative linear relationship with eGFR (P,0.05) after adjustment for potential confounding factors. Conclusion: Among the parameters of 24 h ambulatory BP monitoring, 24 h SBP variability is the only independent risk factor for a decline in renal function in elderly and very elderly male hypertensive patients with well-controlled BP. Keywords: hypertension, elderly male, blood pressure variability, estimated glomerular filtration rate Introduction Correspondence: Fan Wang Department of Geriatric Cardiology, Chinese PLA General Hospital, No 28, Fuxing Road, Beijing 100853, China Tel/fax +86 10 6687 6349 Email 533 submit your manuscript | www.dovepress.com Clinical Interventions in Aging 2018:13 533–540 Dovepress © 2018 Wang et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/CIA.S161752 Powered by TCPDF (www.tcpdf.org) The prevalence of chronic kidney disease (CKD) or end-stage renal disease is growing rapidly, particularly in the elderly population, and is thus becoming a global economic burden. Impaired renal function is mainly caused by high blood pressure (BP) as a result of contributing factors such as aging, diabetes and atherosclerotic disease.1,2 While the use of antihypertensive drugs can help to control hypertension, hypertensive patients with well-controlled BP still suffer from a decline in renal function.3 Therefore, for hypertensive patients with well-controlled BP, it is important to identify the potential Dovepress Clinical Interventions in Aging downloaded from https://www.dovepress.com/ by 88.198.20.149 on 03-Oct-2019 For personal use only. Wang et al mechanisms involved with BP variability (BPV) and renal decline other than those that are already known, including BP, blood lipids and age. Ambulatory BP monitoring (ABPM) has been shown to be a better predictor of target organ damage, cardiovascular (CV) risk and clinical outcomes than office BP measurements in the clinic setting.4 BPV can be demonstrated by ABPM, which reflects BP fluctuation within a certain period of time and is usually defined by the standard deviation of BP. Accumulating evidence has also shown that BPV observed during 24 h ABPM was also associated with an increased risk of target organ damage and early atherosclerosis in a manner which was independent of mean BP levels.5,6 Several general populationbased studies have reported that measures of 24 h BPV could serve as an independent predictor for CV events and all-cause mortality.7,8 More recently, an increasing body of evidence has shown that increased BPV can predict CV events and all-cause mortality in patients with CKD.9,10 One cross-sectional study has demonstrated an association between short-term BPV and albuminuria in hypertensive patients.11 Therefore, increased BPV is a correlative factor which can be used to predict the development, progression and severity of renal organ damage in patients with hypertension and CKD.12 In the elderly population, the aging process causes a reduction in neurologic function and an increase in vascular stiffness, thus resulting in BPV.13 However, little is known about the association between BPV and the decline in renal function in elderly hypertensive patients with well-controlled BP. Therefore, in this study, we monitored 24 h ABPM and estimated glomerular filtration rate (eGFR) in elderly and very elderly male hypertensive patients with wellcontrolled BP during a period of hospitalization. Patients and methods Study subjects We enrolled 484 patients who were hospitalized at the Department of Geriatric Cardiology of the Chinese People’s Liberation Army (PLA) General Hospital between January 2014 and December 2016, and met our specific inclusion criteria: 1) male gender and older than 60 years, 2) nonsmoking, 3) diagnosed with essential hypertension in line with the high BP diagnosis standards described in the Chinese Hypertension Prevention and Treatment Guide,14 and 4) receiving antihypertension medication with well-controlled BP over the 3 months prior to hospitalization. The applied standard was that the BP, which was taken twice a day at 9:00 am and 16:00 pm, remained 140/90 mmHg (150/90 mmHg for very elderly patients) for 3 days after hospitalization. 534 Powered by TCPDF (www.tcpd (...truncated)