Effects of enhanced versus reduced vasodilating treatment on brachial and central blood pressure in patients with chronic kidney disease: a randomized controlled trial. Issue 11 (November 2021)

• Record Type: Journal Article
• Authors: Khatir, Dinah Sherzad; Carlsen, Rasmus Kirkeskov; Ivarsen, Per; Jespersen, Bente; Pedersen, Michael; Christensen, Kent Lodberg; Buus, Niels Henrik
• Is Part Of: Journal of hypertension. Volume 39:Issue 11(2021)
• Publication Date: 2021-11
• Subjects: ambulatory blood pressure -- antihypertensive treatment -- augmentation index -- brachial blood pressure -- central blood pressure -- chronic kidney disease -- vasodilation; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000002942
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background: Blood pressure (BP) control is important in chronic kidney disease (CKD), but a reduction in brachial BP may not mirror changes in central aortic BP (cBP) during antihypertensive medication. We hypothesize that a fall in cBP is better reflected during enhanced vasodilation treatment (EVT) compared with reduced vasodilation treatment (RVT) because of different hemodynamic actions of these interventions. Methods: Eighty-one hypertensive CKD stage 3–4 patients (mean measured glomerular filtration rate 36 ml/min per 1.73 m 2 ) were randomized to either EVT based on renin--angiotensin blockade and/or amlodipine or RVT based on nonvasodilating β-blockade (metoprolol). Before randomization and following 18 months of treatment, we performed 24-h ambulatory BP measurements (ABPM) and radial artery pulse wave analysis for estimation of cBP and augmentation index (AIx). Forearm resistance ( R rest ) was determined by venous occlusion plethysmography and arterial stiffness by carotid--femoral pulse wave velocity (PWV). Matched healthy controls were studied once for comparison. Results: Compared with controls, CKD patients had elevated ABPM, cBP and PWV. Although ABPM remained unchanged from baseline to follow-up in both treatment groups, cBP decreased 4.7/2.9 mmHg (systolic/diastolic) during EVT and increased 5.1/1.5 mmHg during RVT (Δ=9.8/4.4 mmHg, P =0.02 for SBP, P = 0.05 for DBP). At follow-up, the difference between systolic cBP and 24-h ABPM (ΔBPsyst ) was negatively associated with heart rate and positively associated with AIx and Rrest (all P < 0.01) but not PWV ( P = 0.32). Conclusion: In CKD patients, EVT and RVT have opposite effects on cBP and the difference between cBP and ambulatory BP is larger for EVT than RVT. Abstract : Supplemental Digital Content is available in the text