Short‐Term Systolic Blood Pressure Variability and Kidney Disease Progression in Patients With Chronic Kidney Disease: Results From C‐STRIDE

BACKGROUND: It is unclear whether short‐term blood pressure variability is associated with renal outcomes in patients with chronic kidney disease. METHODS AND RESULTS: This study analyzed data from participants in the C‐STRIDE (Chinese Cohort Study of Chronic Kidney Disease) who had chronic kidney disease stages 1 to 4. Short‐term blood pressure variability was measured by calculating the weighted SD (w‐SD) of systolic blood pressure (SBP). Renal outcomes were defined as dialysis initiation and/or transplantation. Risk factors associated with w‐SD of SBP were evaluated by linear regression. Associations of short‐term SBP variability with renal outcomes were evaluated by Cox regression. In total, 1421 patients with chronic kidney disease were included in this study (mean age, 49.4±13.6 years; 56.2% men; estimated glomerular filtration rate, 50.5±29.3 mL/min per 1.73 m(2); proteinuria, 0.9 [0.3–2.0] g/d). Mean w‐SD of SBP was 12.6±4.4 mm Hg. w‐SD of SBP was independently associated with older age, 24‐hour SBP, blood pressure circadian pattern, and angiotensin II receptor blocker treatment. During a median follow‐up of 4.9 years, 237 patients developed renal outcomes (37.01 per 1000 patient‐years). The incidence rate increased across the quartiles of w‐SD (log‐rank P=0.005). w‐SD of SBP was associated with an increased risk of renal outcomes, both as a continuous variable (hazard ratio [HR], 1.47; 95% CI, 1.09–1.99) and as a categorical variable (quartile 4 versus quartile 1: HR, 1.60; 95% CI, 1.08–2.36), independent of 24‐hour SBP, daytime SBP, and nighttime SBP. CONCLUSIONS: Short‐term SBP was independently associated with the risk of dialysis initiation and/or transplantation in patients with chronic kidney disease.