• Ciaran J McMullan, Lambers Heerspink Hiddo J HJ Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands., Hans-Henrik Parving, Jamie P Dwyer, John P Forman, and Dick de Zeeuw.
• Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
• Am. J. Kidney Dis. 2014 Nov 1; 64 (5): 714-22.

BackgroundIncreased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points. However, few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney disease outcomes. We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy.Study DesignObservational analysis of IDNT (Irbesartan Diabetic Nephropathy Trial) and the RENAAL (Reduction of End Points in Non-Insulin-Dependent Diabetes With the Angiotensin II Antagonist Losartan) Study.Setting & Participants2,739 participants with type 2 diabetes and nephropathy with at least 1 year of blood pressure measurements available.PredictorsSystolic blood pressure visit-to-visit variability was calculated from the SD of the systolic blood pressure from 4 visits occurring 3-12 months postrandomization.OutcomesThe kidney disease outcome was defined as time to confirmed doubling of serum creatinine level, end-stage renal disease, or death; the cardiovascular outcome was defined as time to cardiovascular death, myocardial infarction, stroke, hospitalization for heart failure, or revascularization.ResultsMean visit-to-visit variability in systolic blood pressure from 3 to 12 months postrandomization was 12.0±6.8(SD)mmHg. Following this ascertainment period, there were 954 kidney disease and 542 cardiovascular events. Greater systolic blood pressure visit-to-visit variability was associated independently with increased risk of the composite kidney disease end point (HR per 1-SD increment, 1.08 [95%CI, 1.01-1.16]; P=0.02) and end-stage renal disease, but not with the cardiovascular outcome.LimitationsObservational study with the potential for confounding.ConclusionsIn diabetic individuals with nephropathy, systolic blood pressure visit-to-visit variability is associated independently with hard kidney disease outcomes.Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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