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. 2017 May 4;6(5):e005661.
doi: 10.1161/JAHA.117.005661.

Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults

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Free PMC article

Graded Association Between Kidney Function and Impaired Orthostatic Blood Pressure Stabilization in Older Adults

Mark Canney et al. J Am Heart Assoc. .
Free PMC article

Abstract

Background: Impaired orthostatic blood pressure (BP) stabilization is highly prevalent in older adults and is a predictor of end-organ injury, falls, and mortality. We sought to characterize the relationship between postural BP responses and the kidney.

Methods and results: We performed a cross-sectional analysis of 4204 participants from The Irish Longitudinal Study on Ageing, a national cohort of community-dwelling adults aged ≥50 years. Beat-to-beat systolic and diastolic BP were measured during a 2-minute active stand test. The primary predictor was cystatin C estimated glomerular filtration rate (eGFR) categorized as follows (mL/min per 1.73 m2): ≥90 (reference, n=1414); 75 to 89 (n=1379); 60 to 74 (n=942); 45 to 59 (n=337); <45 (n=132). We examined the association between eGFR categories and (1) sustained orthostatic hypotension, defined as a BP drop exceeding consensus thresholds (systolic BP drop ≥20 mm Hg±diastolic BP drop ≥10 mm Hg) at each 10-second interval from 60 to 110 seconds inclusive; (2) pattern of BP stabilization, characterized as the difference from baseline in mean systolic BP/diastolic BP at 10-second intervals. The mean age of subjects was 61.6 years; 47% of subjects were male, and the median eGFR was 82 mL/min per 1.73 m2. After multivariable adjustment, participants with eGFR <60 mL/min per 1.73 m2 were approximately twice as likely to have sustained orthostatic hypotension (P=0.008 for trend across eGFR categories). We observed a graded association between eGFR categories and impaired orthostatic BP stabilization, particularly within the first minute of standing.

Conclusions: We report a novel, graded relationship between diminished eGFR and impaired orthostatic BP stabilization. Mapping the postural BP response merits further study in kidney disease as a potential means of identifying those at risk of hypotension-related events.

Keywords: blood pressure measurement/monitoring; cystatin C; glomerular filtration rate; hypotension; kidney; low blood pressure; orthostatic hypotension.

Figures

Figure 1
Figure 1
Flowchart of case ascertainment. eGFR indicates estimated glomerular filtration rate.
Figure 2
Figure 2
Unadjusted (left panel) and multivariable‐adjusted (right panel) estimate of the conditional mean difference (with corresponding 95%CI) in systolic blood pressure from baseline (y axis) at each 10‐second interval during the active stand (x axis) among categories of estimated glomerular filtration rate (eGFR) derived from cystatin C. SBP indicates systolic blood pressure.
Figure 3
Figure 3
Multivariable‐adjusted differences across categories of cystatin C–estimated glomerular filtration rate in the change from baseline in systolic blood pressure (y axis) at each 10‐second interval during the active stand (x axis). Each estimated glomerular filtration rate (eGFR) category is compared to the reference group (eGFR >90 mL/min per 1.73 m2, represented by a horizontal red line): eGFR 75 to 89 mL/min per 1.73 m2 (top left), eGFR 60 to 74 mL/min per 1.73 m2 (top right), eGFR 45 to 59 mL/min per 1.73 m2 (bottom left), eGFR <45 mL/min per 1.73 m2 (bottom right). SBP indicates systolic blood pressure.
Figure 4
Figure 4
Unadjusted (left panel) and multivariable‐adjusted (right panel) estimate of the conditional mean difference (with corresponding 95%CI) in diastolic blood pressure from baseline (y axis) at each 10‐second interval during the active stand (x axis) among categories of estimated glomerular filtration rate derived from cystatin C. DBP indicates diastolic blood pressure.
Figure 5
Figure 5
Unadjusted (left panel) and multivariable‐adjusted (right panel) estimate of the conditional mean difference (with corresponding 95%CI) in systolic blood pressure from baseline (y axis) at each 10‐second interval during the active stand (x axis) among categories of estimated glomerular filtration rate derived from creatinine. SBP indicates systolic blood pressure.
Figure 6
Figure 6
Unadjusted (left panel) and multivariable‐adjusted (right panel) estimate of the conditional mean difference (with corresponding 95%CI) in diastolic blood pressure from baseline (y axis) at each 10‐second interval during the active stand (x axis) among categories of estimated glomerular filtration rate derived from creatinine. DBP indicates diastolic blood pressure.

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