Stepwise increase in the prevalence of isolated systolic hypertension with the stages of chronic kidney disease.
BACKGROUND
Hypertension is common in patients with chronic kidney disease (CKD), and isolated systolic hypertension (ISH) accounts for most patients with inadequate blood pressure (BP) control. However, it remains unclear whether the prevalence of ISH would increase with the advancement of CKD.


METHODS
CKD patients of stages 3, 4 and 5 were recruited (n = 324). Based on office systolic BP (SBP) and diastolic BP (DBP), they were classified into any of the four hypertensive subtypes: normotension (SBP/DBP <140/90 mmHg), isolated diastolic hypertension (IDH, SBP <140 mmHg and DBP >or=90 mmHg), ISH (SBP >or=140 mmHg and DBP <90 mmHg) and systolic-diastolic hypertension (SDH, SBP/DBP >or=140/90 mmHg).


RESULTS
The control rate was 45.7% at stage 3, which decreased with the advancement of CKD (control rate was 51.9%, 40.4% and 38.6% in stage 3, 4 and 5, respectively; P < 0.05). The prevalence of IDH changed from 5.0% to 5.3% and 0% from stage 3 to 4 and 5, while there was no significant change in the prevalence of SDH (15.0%, 14.9% and 15.7% at stage 3, 4 and 5, respectively). There was a stepwise increase in the prevalence of ISH with the stages of CKD (it was 28.1%, 39.4% and 45.7% in stage 3, 4 and 5, respectively). Logistic regression showed that age and CKD stages [compared with stage 3, stage 4 and 5 had 2.57 (95% CI 1.04-6.33) and 3.68 (95% CI 1.09-12.47) folds higher risk to develop ISH, respectively] were independent predictors of ISH.


CONCLUSIONS
The prevalence of ISH increased correspondingly with advanced stages of CKD, which may partially contribute to the increased cardiovascular mortality during the progress of CKD.
Cheng
Li-Tao
LT
Division of Nephrology, Peking University Third Hospital, Haidian District, Beijing 100083, China. ltcheng@bjmu.edu.cn
Gao
Yan-Li
YL
Gu
Yue
Y
Zhang
Li
L
Bi
Shu-Hong
SH
Tang
Wen
W
Wang
Tao
T
D000368:Aged; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D006977:Hypertension, Renal / Q000145:classification / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000145:classification / Q000150:complications* / Q000503:physiopathology; D012307:Risk Factors; D013599:Systole