title: Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study.
abstract: The "reverse dipping" blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a "dipper", "non-dipper" and "reverse dippers" was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis.
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Zengchun
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Department of Pathology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Qunzi
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Ma
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Peng
authors.affiliation: Division of Nephrology, Department of medicine, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510630, China.
authors.forename: Tanqi
authors.initials: T
authors.lastname: Lou
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D018660:Blood Pressure Monitoring, Ambulatory; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002681:China / Q000453:epidemiology; D002940:Circadian Rhythm / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D012307:Risk Factors