Central pulse pressure in chronic kidney disease: a chronic renal insufficiency cohort ancillary study.
Central pulse pressure (PP) can be noninvasively derived using the radial artery tonometric methods. Knowledge of central pressure profiles has predicted cardiovascular morbidity and mortality in several populations of patients, particularly those with known coronary artery disease and those receiving dialysis. Few data exist characterizing central pressure profiles in patients with mild-moderate chronic kidney disease who are not on dialysis. We measured central PP cross-sectionally in 2531 participants in the Chronic Renal Insufficiency Cohort Study to determine correlates of the magnitude of central PP in the setting of chronic kidney disease. Tertiles of central PP were <36 mm Hg, 36 to 51 mm Hg, and >51 mm Hg with an overall mean (+/-SD) of 46+/-19 mm Hg. Multivariable regression identified the following independent correlates of central PP: age, sex, diabetes mellitus, heart rate (negatively correlated), glycosylated hemoglobin, hemoglobin, glucose, and parathyroid hormone parathyroid hormone concentrations. Additional adjustment for brachial mean arterial pressure and brachial PP showed associations for age, sex, diabetes mellitus, weight, and heart rate. Discrete intervals of brachial PP stratification showed substantial overlap within the associated central PP values. The large size of this unique chronic kidney disease cohort provides an ideal situation to study the role of brachial and central pressure measurements in kidney disease progression and cardiovascular disease incidence.
Townsend
Raymond R
RR
University of Pennsylvania, 122 Founders Building, 3400 Spruce St, Philadelphia, PA 19104, USA . townsend@mail.med.upenn.edu
Chirinos
Julio A
JA
Parsa
Afshin
A
Weir
Matthew A
MA
Sozio
Stephen M
SM
Lash
James P
JP
Chen
Jing
J
Steigerwalt
Susan P
SP
Go
Alan S
AS
Hsu
Chi-Yuan
CY
Rafey
Mohammed
M
Wright
Jackson T
JT
Duckworth
Mark J
MJ
Gadegbeku
Crystal A
CA
Joffe
Marshall P
MP
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure / Q000502:physiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012044:Regression Analysis; D012737:Sex Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D010281:Parathyroid Hormone