Central blood pressure and cardiovascular outcomes in chronic kidney disease

CRIC Study Investigators

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background and objectives Central BP measurements provide noninvasive measurement of aortic BP; our objectives were to examine the association of central and brachial BP measurements with risk of cardiovascular outcomes and mortality in patients with CKD and to determine the role of central BP measurement in conjunction with brachial BP in estimating cardiovascular risk. Design, setting, participants, &measurements Inaprospective, longitudinal study (the Chronic Renal Insufficiency Cohort), central BP was measured in participants with CKD using the SphygmoCorPVx System. Cox proportional hazards models were used for analyses. Results Mean age of the participants (n=2875) was 60 years old. After a median follow-up of 5.5 years, participants in the highest quartile of brachial systolic BP (≥138 mm Hg) were at 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) compared with those in the lowest quartile. Participants in the highest quartile of central systolic BP 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) compared with participants in the lowest quartile. Conclusions We show that elevated brachial and central BP measurements are both associated with higher risk of cardiovascular disease outcomes in patients with CKD. Measurement of central BP does not improve the ability to predict cardiovascular disease outcomes or mortality in patients with CKD compared with brachial BP measurement.

Original languageEnglish (US)
Pages (from-to)585-595
Number of pages11
JournalClinical Journal of the American Society of Nephrology
Volume13
Issue number4
DOIs
StatePublished - Apr 6 2018

Bibliographical note

Funding Information:
Funding for the Chronic Renal Insufficiency Cohort (CRIC) Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this work was supported in part by Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science award National Institutes of Health (NIH)/ National Center for Advancing Translational Sciences (NCATS) UL1TR000003, Johns Hopkins University grant UL1 TR-000424, University of Maryland General Clinical Research Center grant M01 RR-16500, the Clinical and V 2016.04.26 Translational Science Collaborative of Cleveland, grant UL1TR000439 from the NCATS component of the NIH and the NIH Roadmap for Medical Research, Michigan Institute for Clinical and Health Research grant UL1TR000433, University of Illinois at Chicago Clinical and Translational Science Award grant UL1RR029879, Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases grant P20 GM109036, and Kaiser Per-manente NIH/National Center for Research Resources University of San Francisco Clinical & Translational Science Institute grant UL1 RR-024131.

Funding Information:
Funding for the Chronic Renal Insufficiency Cohort (CRIC) Study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this work was supported in part by Perelman School of Medicine at the University of Pennsylvania Clinical and Translational Science award National Institutes of Health (NIH)/ National Center for Advancing Translational Sciences (NCATS) UL1TR000003, Johns Hopkins University grant UL1 TR-000424, University of Maryland General Clinical Research Center grant M01 RR-16500, the Clinical and V 2016.04.26 Translational Science Collaborative of Cleveland, grant UL1TR000439 from the NCATS component of the NIH and the NIH Roadmap for Medical Research, Michigan Institute for Clinical and Health Research grant UL1TR000433, University of Illinois at Chicago Clinical and Translational Science Award grant UL1RR029879, Tulane Center of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases grant P20 GM109036, and Kaiser Permanente NIH/National Center for Research Resources University of San Francisco Clinical & Translational Science Institute grant UL1 RR-024131.

Publisher Copyright:
© 2018 by the American Society of Nephrology.

Keywords

  • Aorta
  • Arterial pressure
  • Blood pressure
  • Cardiovascular diseases
  • Chronic
  • Confidence intervals
  • Follow-Up studies
  • Humans
  • Longitudinal studies
  • Middle aged
  • Proportional hazards models
  • Prospective studies
  • Renal insufficiency
  • Risk factors

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