title: Association between 24-hour blood pressure variability and chronic kidney disease: a cross-sectional analysis of African Americans participating in the Jackson heart study.
abstract: BACKGROUND
  Studies suggest 24-h blood pressure (BP) variability has prognostic value for cardiovascular disease. Several factors associated with high 24-h BP variability are also common among individuals with chronic kidney disease (CKD). We hypothesized 24-h BP variability would be higher for individuals with versus without CKD.
  
  
  METHODS
  We analyzed 1,022 Jackson Heart Study participants who underwent ambulatory blood pressure monitoring (ABPM). Twenty-four hour BP variability was defined by two metrics: day-night standard deviation (SDdn) and average real variability (ARV). CKD was defined as ACR ≥ 30 mg/g or eGFR <60 mL/min/1.73 m(2).
  
  
  RESULTS
  The mean SDdn of systolic BP (SBP) was 10.2 ± 0.2 and 9.1 ± 0.1 mmHg and the mean ARV of SBP was 9.2 ± 0.2 and 8.6 ± 0.1 mmHg for those with and without CKD, respectively (each p ≤ 0.001). After adjustment for age and sex, SDdn and ARV were 0.98 mmHg (95 % CI 0.59, 1.38) and 0.52 mmHg (95 % CI 0.18, 0.86), respectively, higher among participants with versus without CKD. These differences were not statistically significant after further multivariable adjustment including 24-h mean SBP. Older age, and higher total cholesterol and 24-h mean SBP were associated with higher SDdn and ARV of SBP among participants with CKD. Mean SDdn and ARV of diastolic BP (DBP) were higher for participants with versus without CKD but these associations were not present after multivariable adjustment.
  
  
  CONCLUSIONS
  Data from the current study suggest that CKD is associated with higher 24-h BP variability, but the association is primarily explained by higher mean BP among those with CKD.
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230 J, Birmingham, AL, 35294, USA. rmdeitz@uab.edu.
authors.forename: Rikki M
authors.initials: RM
authors.lastname: Tanner
authors.affiliation: Columbia University Medical Center, New York, NY, USA. ds2231@cumc.columbia.edu.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. adreisbach@umc.edu.
authors.forename: Albert W
authors.initials: AW
authors.lastname: Dreisbach
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230 J, Birmingham, AL, 35294, USA. apcarson@uab.edu.
authors.forename: April P
authors.initials: AP
authors.lastname: Carson
authors.affiliation: Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. efox@umc.edu.
authors.forename: Ervin R
authors.initials: ER
authors.lastname: Fox
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230 J, Birmingham, AL, 35294, USA. pmuntner@uab.edu.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
mesh_terms: D001741:Black or African American; D000367:Age Factors; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D003971:Diastole; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D013599:Systole
chemical_list: D008076:Cholesterol, HDL; D002784:Cholesterol