Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease

Kirkham, Frances A, Rankin, Philip, Parekh, Nikesh, Holt, Stephen G and Rajkumar, Chakravarthi (2019) Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease. Journal of Nephrology. ISSN 1724-6059

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Abstract

Objective

Orthostatic hypotension (OH) has a significant association with cardiovascular disease. OH becomes more common in older age, as does arterial stiffness, shown to be independently associated with impaired baroreflex sensitivity and OH. Measurement of arterial compliance and central blood pressures are increasingly important, with evidence that central BP more closely correlates to end-organ damage and mortality than peripheral measurements. Patients with chronic kidney disease (CKD) are high risk for cardiovascular events, which can be predicted through measures of arterial compliance. We hypothesised that OH is associated with arterial stiffness and central blood pressure in CKD patients.

Design/setting

We tested this hypothesis within the arterial compliance and oxidant stress as predictors of loss of renal function, morbidity and mortality in chronic kidney disease (ACADEMIC) study, a single-centre prospective observational study of the progression of arterial stiffness and renal function.

Participants

One hundred and forty-six patients with CKD 3 or 4.

Measurements

Twenty-four-hour ambulatory BP monitoring with postural sensing (DIASYS Integra 2, Novacor France); central systolic and diastolic BP (cSBP and cDBP) and aortic Augmentation Index using Sphygmocor® (Atcor, Australia); Carotid-femoral pulse wave velocity (cfPWV) using Complior® (ALAM Medical, France).

Results

Twenty-three patients had a postural SBP fall (prevalence 15.8%), with mean drop 7 mmHg. Patients with OH had higher cfPWV (15.2 m/s vs 12.7 m/s in patients without OH, p < 0.001) and central SBP (147.5 vs 135.7, p = 0.012). Regression analysis gave an odds ratio (OR) of orthostatic SBP fall for cfPWV of 1.46 (95% CI 1.16–1.84, p = 0.001) and 1.03 for cSBP (95% CI 1.004–1.06, p = 0.024) after adjustment for cardiovascular risk factors.

Conclusion

Aortic stiffness and central SBP are independently associated with orthostatic SBP fall in CKD patients. This suggests that enhanced arterial stiffness may be an underlying mechanism in baroreflex dysfunction, and may partly explain the vascular risk in CKD patients.

Item Type: Article
Keywords: Elderly Medicine, Aortic stiffness, Chronic kidney disease, Orthostatic hypotension, Pulse wave velocity, central blood pressure
Schools and Departments: Brighton and Sussex Medical School > Clinical and Experimental Medicine
Depositing User: Georgina Sword-Daniels
Date Deposited: 25 Oct 2019 15:27
Last Modified: 21 Nov 2019 14:00
URI: http://sro.sussex.ac.uk/id/eprint/87241

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