Association between long-term pulse pressure trajectories and risk of end-stage renal diseases in incident malignant hypertensive nephropathy: a cohort study. Issue 1 (4th August 2020)

• Record Type: Journal Article
• Authors: Zhuang, Yi; Ding, Caiyan; Xu, Yajing; Ding, Zhongqin; Yu, Dahai
• Is Part Of: Blood pressure monitoring. Volume 26:Issue 1(2021)
• Page Start: 14
• Page End: 21
• Publication Date: 2020-08-04
• Subjects: malignant hypertension -- pulse pressure -- trajectory; Blood pressure -- Measurement -- Periodicals; Blood Pressure Determination -- Periodicals; Blood Pressure Monitoring, Ambulatory -- Periodicals; Blood Pressure Monitors -- Periodicals; Hypertension -- Periodicals; 612.140287
• DOI: 10.1097/MBP.0000000000000477
• Languages: English
• ISSNs: 1359-5237

Abstract

Abstract : Objective: The trajectories of pulse pressure (PP) might affect the prognosis of malignant hypertensive nephropathy (MHN). We aimed to describe the association between PP trajectories and the future risk of end-stage renal disease and to identify and compare the associated patient characteristics of any distinct trajectory patterns in MHN patients. Methods: Patients with newly diagnosed biopsy-proven MHN 2010–2015 were included. Latent class growth analysis was applied to the PP measured over 3 years prior to biopsy to identify distinct trajectories. Concurrent systolic blood pressure, diastolic blood pressure, plasma creatinine, and 24-h urine protein measurements for each trajectory group were modelled using generalized estimating equations. The risk of end-stage renal disease (with kidney replacement therapy as a proxy) was estimated using Logistic regression. Results: Two hundred three patients were included (median-age 34 years, and 19.7% female). A two-group cubic model was optimal, with trajectories distinguished by the rate of PP and absolute level at final measurement. Trajectory Group-1 ( n = 84) was characterized by 'first-increased-then-decreased' PP and trajectory Group-2 ( n = 119) was characterized by 'first-decreased-then-increased' PP over 3 years prior to biopsy. Systolic and diastolic blood pressures, plasma creatinine, and 24-h urine protein were differed by the trajectory group. Baseline characteristics differed substantially between trajectory groups. Compared with Group-1, Group-2 had a 66% greater risk of developing into end-stage renal disease in the subsequent 3 years. Conclusions: Two distinct 3-year trajectories for PP exist with MHN. Early introduction of intensive antihypertensive treatment might delay the development of end-stage renal disease among patients with malignant hypertension.