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Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study

RATIONALE & OBJECTIVE: There are limited data about the prevalence and prognostic significance of orthostatic hypo- and hypertension in patients with chronic kidney disease. The objective of this study is to determine the prevalence of orthostatic hypo- and hypertension in a cohort of patients w...

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Autores principales: Rouabhi, Mohamed, Durieux, Jared, Al-Kindi, Sadeer, Cohen, Jordana B., Townsend, Raymond R., Rahman, Mahboob
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039407/
https://www.ncbi.nlm.nih.gov/pubmed/33851116
http://dx.doi.org/10.1016/j.xkme.2020.10.012
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author Rouabhi, Mohamed
Durieux, Jared
Al-Kindi, Sadeer
Cohen, Jordana B.
Townsend, Raymond R.
Rahman, Mahboob
author_facet Rouabhi, Mohamed
Durieux, Jared
Al-Kindi, Sadeer
Cohen, Jordana B.
Townsend, Raymond R.
Rahman, Mahboob
author_sort Rouabhi, Mohamed
collection PubMed
description RATIONALE & OBJECTIVE: There are limited data about the prevalence and prognostic significance of orthostatic hypo- and hypertension in patients with chronic kidney disease. The objective of this study is to determine the prevalence of orthostatic hypo- and hypertension in a cohort of patients with chronic kidney disease and examine their association with clinical outcomes. STUDY DESIGN: Prospective cohort study: Chronic Renal Insufficiency Cohort (CRIC) Study. SETTING & POPULATION: 7 clinical centers, participants with chronic kidney disease. EXPOSURES: Orthostatic hypotension (decline in systolic blood pressure [BP] > 20 mm Hg) and orthostatic hypertension (increase in systolic BP > 20 mm Hg) from seated to standing position. OUTCOMES: Cardiovascular and kidney outcomes and mortality. ANALYTICAL APPROACH: Logistic regression was used to determine factors associated with orthostatic hypo- and hypertension; Cox regression was used to examine associations with clinical outcomes. RESULTS: Mean age of study population (n = 3,873) was 58.1 ± 11.0 years. There was a wide distribution of change in systolic BP from seated to standing (from −73.3 to +60.0 mm Hg); 180 participants (4.6%) had orthostatic hypotension and 81 (2.1%) had orthostatic hypertension. Diabetes, reduced body mass index, and β-blocker use were independently associated with orthostatic hypotension. Black race and higher body mass index were independently associated with orthostatic hypertension. After a median follow-up of 7.9 years, orthostatic hypotension was independently associated with high risk for cardiovascular (HR, 1.12; 95% CI, 1.03-1.21) but not kidney outcomes or mortality. Orthostatic hypertension was independently associated with high risk for kidney (HR, 1.51; 96% CI, 1.14-1.97) but not cardiovascular outcomes or mortality. LIMITATIONS: Orthostatic change in BP was ascertained at a single visit. CONCLUSIONS: Orthostatic hypotension was independently associated with higher risk for cardiovascular outcomes, whereas orthostatic hypertension was associated with higher risk for kidney outcomes. These findings highlight the importance of orthostatic BP measurement in practice and the need for future investigation to understand the mechanisms and potential interventions to minimize the risk associated with orthostatic changes in BP.
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spelling pubmed-80394072021-04-12 Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study Rouabhi, Mohamed Durieux, Jared Al-Kindi, Sadeer Cohen, Jordana B. Townsend, Raymond R. Rahman, Mahboob Kidney Med Original Research RATIONALE & OBJECTIVE: There are limited data about the prevalence and prognostic significance of orthostatic hypo- and hypertension in patients with chronic kidney disease. The objective of this study is to determine the prevalence of orthostatic hypo- and hypertension in a cohort of patients with chronic kidney disease and examine their association with clinical outcomes. STUDY DESIGN: Prospective cohort study: Chronic Renal Insufficiency Cohort (CRIC) Study. SETTING & POPULATION: 7 clinical centers, participants with chronic kidney disease. EXPOSURES: Orthostatic hypotension (decline in systolic blood pressure [BP] > 20 mm Hg) and orthostatic hypertension (increase in systolic BP > 20 mm Hg) from seated to standing position. OUTCOMES: Cardiovascular and kidney outcomes and mortality. ANALYTICAL APPROACH: Logistic regression was used to determine factors associated with orthostatic hypo- and hypertension; Cox regression was used to examine associations with clinical outcomes. RESULTS: Mean age of study population (n = 3,873) was 58.1 ± 11.0 years. There was a wide distribution of change in systolic BP from seated to standing (from −73.3 to +60.0 mm Hg); 180 participants (4.6%) had orthostatic hypotension and 81 (2.1%) had orthostatic hypertension. Diabetes, reduced body mass index, and β-blocker use were independently associated with orthostatic hypotension. Black race and higher body mass index were independently associated with orthostatic hypertension. After a median follow-up of 7.9 years, orthostatic hypotension was independently associated with high risk for cardiovascular (HR, 1.12; 95% CI, 1.03-1.21) but not kidney outcomes or mortality. Orthostatic hypertension was independently associated with high risk for kidney (HR, 1.51; 96% CI, 1.14-1.97) but not cardiovascular outcomes or mortality. LIMITATIONS: Orthostatic change in BP was ascertained at a single visit. CONCLUSIONS: Orthostatic hypotension was independently associated with higher risk for cardiovascular outcomes, whereas orthostatic hypertension was associated with higher risk for kidney outcomes. These findings highlight the importance of orthostatic BP measurement in practice and the need for future investigation to understand the mechanisms and potential interventions to minimize the risk associated with orthostatic changes in BP. Elsevier 2021-02-06 /pmc/articles/PMC8039407/ /pubmed/33851116 http://dx.doi.org/10.1016/j.xkme.2020.10.012 Text en © 2021 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research
Rouabhi, Mohamed
Durieux, Jared
Al-Kindi, Sadeer
Cohen, Jordana B.
Townsend, Raymond R.
Rahman, Mahboob
Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
title Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
title_full Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
title_fullStr Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
title_full_unstemmed Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
title_short Orthostatic Hypertension and Hypotension and Outcomes in CKD: The CRIC (Chronic Renal Insufficiency Cohort) Study
title_sort orthostatic hypertension and hypotension and outcomes in ckd: the cric (chronic renal insufficiency cohort) study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8039407/
https://www.ncbi.nlm.nih.gov/pubmed/33851116
http://dx.doi.org/10.1016/j.xkme.2020.10.012
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