title: Association of BP variability with mortality among African Americans with CKD.
abstract: OBJECTIVE
  Increased systolic BP visit-to-visit variability (SBV) may be associated with higher overall mortality and cardiovascular events. However, few studies have examined these associations in patients with CKD, and the relation of SBV with CKD progression and ESRD has not been shown. This study analyzed the association of SBV with overall mortality, cardiovascular mortality, cardiovascular events, and renal events among individuals enrolled in the African American Study of Kidney Disease (AASK) trial.
  
  
  METHODS
  This was a prospective observational study of 908 participants during the trial phase of the AASK study, with at least 1 year of BP measurements available and followed for 3-6.4 years. SBV was calculated as the SD of the systolic pressure from five visits occurring 3-12 months after randomization. The association of SBV with risk of overall mortality, cardiovascular mortality, a composite of fatal and nonfatal cardiovascular events, and a composite of renal events was assessed using proportional hazards regression and adjusting for multiple potential confounders.
  
  
  RESULTS
  Greater SBV was associated with higher overall mortality. The adjusted hazard ratio (95% confidence interval) was 2.82 (1.14-6.95) comparing the highest with lowest tertile of SBV. A similar comparison revealed that greater SBV was also associated with cardiovascular mortality (adjusted hazard ratio, 4.91; 1.12-21.50). SBV was associated with both the cardiovascular renal composite endpoints in unadjusted but not adjusted analyses.
  
  
  CONCLUSIONS
  In African Americans with CKD, SBV is strongly and independently associated with overall and cardiovascular mortality.
authors.affiliation: Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. cmcmullan1@partners.org
authors.forename: Ciaran J
authors.initials: CJ
authors.lastname: McMullan
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Robert A
authors.initials: RA
authors.lastname: Phillips
authors.forename: John P
authors.initials: JP
authors.lastname: Forman
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018572:Disease-Free Survival; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents