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Albuminuria, renal dysfunction and circadian blood pressure rhythm in older men: a population-based longitudinal cohort study.

Xu H, Huang X, Risérus U, Cederholm T, Sjögren P, Lindholm B, Ärnlöv J, Carrero JJ - Clin Kidney J (2015)

Bottom Line: Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects.UAER associated with circadian BP rhythm both cross-sectionally and longitudinally.Concurrent renal dysfunction modifies and exacerbates these associations.

View Article: PubMed Central - PubMed

Affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden.

ABSTRACT

Background: Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects. We investigated associations and interactions of these two risk factors with circadian BP rhythm variation and non-dipper pattern progression in community-dwelling older men.

Methods: This was a cross-sectional and longitudinal analyses in the third and fourth cycles of the Uppsala Longitudinal Study of Adult Men, including 1051 men (age 71 years) with assessments on urinary albumin excretion rate (UAER), 24-h ambulatory BP monitoring (ABPM) and cystatin-C-estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years. Study outcomes were ABMP changes and non-dipping BP pattern (prevalence and progression).

Results: UAER associated with circadian BP rhythm both cross-sectionally and longitudinally. Longitudinally, significant interactions were observed between UAER and kidney dysfunction (eGFR < 60 mL/min/1.73 m(2)) in its association with the changes of both night-time systolic BP (SBP) and night-day SBP ratio. After stratification, UAER strongly predicted night-day SBP ratio change only in those with concurrent kidney dysfunction. At re-examination, 221 new cases of non-dipper were identified. In multivariable logistic models, high UAER associated with increased likelihood of non-dipper progression, but more strongly so among individuals with concurrent kidney dysfunction. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER.

Conclusions: UAER associates with circadian BP rhythm variation and non-dipper progression in elderly men. Concurrent renal dysfunction modifies and exacerbates these associations.

No MeSH data available.


Related in: MedlinePlus

Flowchart of the participants. Flow chart depicting the selection of individuals for the current investigation including causes for exclusion of participants. ULSAM, Uppsala Longitudinal Study of Adult Men; UAER, urinary albumin excretion rate; ABPM, ambulatory blood pressure monitoring.
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SFV068F1: Flowchart of the participants. Flow chart depicting the selection of individuals for the current investigation including causes for exclusion of participants. ULSAM, Uppsala Longitudinal Study of Adult Men; UAER, urinary albumin excretion rate; ABPM, ambulatory blood pressure monitoring.

Mentions: The present study is based on the Uppsala Longitudinal Study of Adult Men (http://www.pubcare.uu.se/ULSAM/), when participants were 70–71 years old (1991–95; n = 1221). We excluded 170 subjects who were missing albuminuria, serum cystatin C and/or 24-h ambulatory BP monitoring (ABPM) data, leaving 1051 men for the cross-sectional analysis. Of these 1051 individuals, 333 died or were lost to follow-up before a re-examination taking place 6 years later when the participants were ∼77 years old. Of the 718 men who attended the re-examination, 144 were excluded due to missing ABPM records, leaving 574 men for the longitudinal analysis (Figure 1). No major characteristics differed between included and non-included participants at re-examination (Supplementary Table S1). All participants gave written consent, and the Ethics Committee of Uppsala University approved the study.Fig. 1.


Albuminuria, renal dysfunction and circadian blood pressure rhythm in older men: a population-based longitudinal cohort study.

Xu H, Huang X, Risérus U, Cederholm T, Sjögren P, Lindholm B, Ärnlöv J, Carrero JJ - Clin Kidney J (2015)

Flowchart of the participants. Flow chart depicting the selection of individuals for the current investigation including causes for exclusion of participants. ULSAM, Uppsala Longitudinal Study of Adult Men; UAER, urinary albumin excretion rate; ABPM, ambulatory blood pressure monitoring.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4581386&req=5

SFV068F1: Flowchart of the participants. Flow chart depicting the selection of individuals for the current investigation including causes for exclusion of participants. ULSAM, Uppsala Longitudinal Study of Adult Men; UAER, urinary albumin excretion rate; ABPM, ambulatory blood pressure monitoring.
Mentions: The present study is based on the Uppsala Longitudinal Study of Adult Men (http://www.pubcare.uu.se/ULSAM/), when participants were 70–71 years old (1991–95; n = 1221). We excluded 170 subjects who were missing albuminuria, serum cystatin C and/or 24-h ambulatory BP monitoring (ABPM) data, leaving 1051 men for the cross-sectional analysis. Of these 1051 individuals, 333 died or were lost to follow-up before a re-examination taking place 6 years later when the participants were ∼77 years old. Of the 718 men who attended the re-examination, 144 were excluded due to missing ABPM records, leaving 574 men for the longitudinal analysis (Figure 1). No major characteristics differed between included and non-included participants at re-examination (Supplementary Table S1). All participants gave written consent, and the Ethics Committee of Uppsala University approved the study.Fig. 1.

Bottom Line: Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects.UAER associated with circadian BP rhythm both cross-sectionally and longitudinally.Concurrent renal dysfunction modifies and exacerbates these associations.

View Article: PubMed Central - PubMed

Affiliation: Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Intervention and Technology , Karolinska Institutet , Stockholm , Sweden.

ABSTRACT

Background: Both albuminuria and kidney dysfunction may affect circadian blood pressure (BP) rhythm, while exacerbating each other's effects. We investigated associations and interactions of these two risk factors with circadian BP rhythm variation and non-dipper pattern progression in community-dwelling older men.

Methods: This was a cross-sectional and longitudinal analyses in the third and fourth cycles of the Uppsala Longitudinal Study of Adult Men, including 1051 men (age 71 years) with assessments on urinary albumin excretion rate (UAER), 24-h ambulatory BP monitoring (ABPM) and cystatin-C-estimated glomerular filtration rate (eGFR). Of these, 574 men attended re-examination after 6 years. Study outcomes were ABMP changes and non-dipping BP pattern (prevalence and progression).

Results: UAER associated with circadian BP rhythm both cross-sectionally and longitudinally. Longitudinally, significant interactions were observed between UAER and kidney dysfunction (eGFR < 60 mL/min/1.73 m(2)) in its association with the changes of both night-time systolic BP (SBP) and night-day SBP ratio. After stratification, UAER strongly predicted night-day SBP ratio change only in those with concurrent kidney dysfunction. At re-examination, 221 new cases of non-dipper were identified. In multivariable logistic models, high UAER associated with increased likelihood of non-dipper progression, but more strongly so among individuals with concurrent kidney dysfunction. These associations were evident also in the subpopulation of non-diabetics and in participants with normal range UAER.

Conclusions: UAER associates with circadian BP rhythm variation and non-dipper progression in elderly men. Concurrent renal dysfunction modifies and exacerbates these associations.

No MeSH data available.


Related in: MedlinePlus