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Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease

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Abstract

Objective

Orthostatic hypotension (OH) has a significant association with cardiovascular disease. OH becomes more common in older age, as does arterial stiffness, shown to be independently associated with impaired baroreflex sensitivity and OH. Measurement of arterial compliance and central blood pressures are increasingly important, with evidence that central BP more closely correlates to end-organ damage and mortality than peripheral measurements. Patients with chronic kidney disease (CKD) are high risk for cardiovascular events, which can be predicted through measures of arterial compliance. We hypothesised that OH is associated with arterial stiffness and central blood pressure in CKD patients.

Design/setting

We tested this hypothesis within the arterial compliance and oxidant stress as predictors of loss of renal function, morbidity and mortality in chronic kidney disease (ACADEMIC) study, a single-centre prospective observational study of the progression of arterial stiffness and renal function.

Participants

One hundred and forty-six patients with CKD 3 or 4.

Measurements

Twenty-four-hour ambulatory BP monitoring with postural sensing (DIASYS Integra 2, Novacor France); central systolic and diastolic BP (cSBP and cDBP) and aortic Augmentation Index using Sphygmocor® (Atcor, Australia); Carotid-femoral pulse wave velocity (cfPWV) using Complior® (ALAM Medical, France).

Results

Twenty-three patients had a postural SBP fall (prevalence 15.8%), with mean drop 7 mmHg. Patients with OH had higher cfPWV (15.2 m/s vs 12.7 m/s in patients without OH, p < 0.001) and central SBP (147.5 vs 135.7, p = 0.012). Regression analysis gave an odds ratio (OR) of orthostatic SBP fall for cfPWV of 1.46 (95% CI 1.16–1.84, p = 0.001) and 1.03 for cSBP (95% CI 1.004–1.06, p = 0.024) after adjustment for cardiovascular risk factors.

Conclusion

Aortic stiffness and central SBP are independently associated with orthostatic SBP fall in CKD patients. This suggests that enhanced arterial stiffness may be an underlying mechanism in baroreflex dysfunction, and may partly explain the vascular risk in CKD patients.

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Authors and Affiliations

  1. Department of Elderly Care and Stroke Medicine, Brighton and Sussex University Hospitals Trust, Brighton, BN2 5BE, UK

    Frances A. Kirkham, Philip Rankin, Nikesh Parekh & Chakravarthi Rajkumar

  2. Department of Medicine, Brighton and Sussex Medical School, University of Sussex, Brighton, UK

    Nikesh Parekh, Stephen G. Holt & Chakravarthi Rajkumar

  3. Department of Nephrology, Brighton and Sussex University Hospitals Trust, Brighton, UK

    Stephen G. Holt

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  1. Frances A. Kirkham
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  2. Philip Rankin
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  5. Chakravarthi Rajkumar
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Contributions

FK study data analysis, interpretation, manuscript preparation. PR data analysis, interpretation, manuscript preparation. NP data analysis, interpretation, manuscript preparation. SH study design and conception, acquisition of data, manuscript preparation. CR study design and conception, acquisition of data, analysis, interpretation, manuscript preparation.

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Correspondence to Frances A. Kirkham.

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The authors declare that they have no conflict of interest.

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This study was approved by the West Sussex Research Ethics Committee and was conducted in accordance with Good Clinical Practice Guidelines and the Declaration of Helsinki.

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Patients gave written informed consent.

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Kirkham, F.A., Rankin, P., Parekh, N. et al. Aortic stiffness and central systolic pressure are associated with ambulatory orthostatic BP fall in chronic kidney disease. J Nephrol 33, 317–324 (2020). https://doi.org/10.1007/s40620-019-00655-6

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  • DOI: https://doi.org/10.1007/s40620-019-00655-6

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