Riser BP Pattern More Common in CKD, Diabetes

NEW YORK—Patients with chronic kidney disease (CKD) and those with type 2 diabetes are more likely to have a riser blood pressure (BP) pattern than individuals without these conditions, according to findings reported at the American Society of Hypertension annual meeting.

A riser BP pattern, in which BP increases rather than dips during sleep, is associated with a very high risk of cardiovascular disease (CVD). In separate studies examining data from the Hygia Project conducted in northwest Spain, investigators found that a riser BP pattern was more than 2.5 times more prevalent among CKD than non-CKD patients and more than two times more prevalent among those with than without type 2 diabetes. In their study abstracts, investigators concluded that their findings suggest that CKD and type 2 diabetes be included among the conditions for which ambulatory BP monitoring (ABPM) “is mandatory for proper evaluation of CVD risk as well as a means to establish the most adequate therapeutic scheme to control nighttime BP and to increase CVD event-free survival.”

In one study, Alfonso Otero, MD, PhD, of Complego Hospitalario Universitario in Ourense, Spain, and colleagues analyzed data from 10,271 hypertensive patients. Of these, 3,227 had CKD, defined as an estimated glomerular filtration rate below 60 mL/min/1.73 m2, albuminuria, or both at least two times three or more months apart. At the time of the study, 568 of patients with CKD and 2,234 of those without CKD were not receiving treatment for hypertension. The prevalence of a riser BP pattern was 17.6% in the CKD patients compared with 7.1% in the non-CKD group, a significant difference between the groups.

The other study, by Ana Moya, MD, of Gerencia de Atension Primaria de Pontevedra, Spain, and collaborators examined data from 12,765 hypertensive patients, of whom 2,954 had type 2 diabetes. The prevalence of a riser BP pattern was significantly greater in the diabetics than nondiabetics (19.9% vs. 8.1%).

Elevated sleep BP mean values were the major basis for the diagnosis of hypertension, inadequate BP control, or both, in the CKD patients and diabetics. Among the uncontrolled hypertensive CKD patients, almost 91% had nocturnal hypertension; among uncontrolled hypertensive diabetics, 89% had nocturnal hypertension.

For the study, the researchers assessed circadian BP pattern using 48-hour ABPM. They defined hypertension as awake systolic/diastolic BP mean values of 135/85 mm Hg or higher or asleep systolic/diastolic BP mean values of 120/70 mm Hg or higher, or the use of BP-lowering treatment.

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