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Augmented resting beat-to-beat blood pressure variability in patients with chronic kidney disease

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Abstract

Purpose

Our aim was to test the hypothesis that patients with chronic kidney disease (CKD) would exhibit augmented resting beat-to-beat blood pressure variability (BPV) that is associated with poor clinical outcomes independent of mean blood pressure (BP). In addition, since the arterial baroreflex plays a critical role in beat-to-beat BP regulation, we further hypothesized that an impaired baroreflex control would be associated with an augmented resting beat-to-beat BPV.

Methods

In 25 sedentary patients with CKD stages III–IV (62 ± 9 years) and 20 controls (57 ± 10 years), resting beat-to-beat BP (finger photoplethysmography) and heart rate (electrocardiography) were continuously measured for 10 min. We calculated the standard deviation (SD), average real variability (ARV) and other indices of BPV. The sequence technique was used to estimate spontaneous cardiac baroreflex sensitivity.

Results

Compared with controls (CON), the CKD group had significantly increased resting BPV. The ARV (2.2 ± 0.6 versus 1.6 ± 0.5 mmHg, P < 0.001; 1.6 ± 0.7 versus 1.3 ± 0.3 mmHg, P = 0.039; 1.4 ± 0.5 versus 1.0 ± 0.2 mmHg, P < 0.001) of systolic, diastolic and mean BP, respectively, was increased in CKD versus controls. Other traditional measures of variability showed similar results. The cardiac baroreflex sensitivity was lower in CKD compared with controls (CKD: 8.4 ± 4.5 ms/mmHg versus CON: 14.0 ± 8.2 ms/mmHg, P = 0.008). In addition, cardiac baroreflex sensitivity was negatively associated with BPV [systolic blood pressure (SBP) ARV; r = −0.44, P = 0.003].

Conclusion

In summary, our data demonstrate that patients with CKD have augmented beat-to-beat BPV and lower cardiac baroreflex sensitivity. BPV and cardiac baroreflex sensitivity were negatively correlated in this cohort. These findings may further our understanding about cardiovascular dysregulation observed in patients with CKD.

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Funding

Supported by NIH R01HL135183; NIH R33AT10457; NIH NCATS KL2TR002381; and VA Merit I01CX001065.

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Authors and Affiliations

  1. Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA

    Jeann L. Sabino-Carvalho, Jinhee Jeong, Dana DaCosta & Jeanie Park

  2. Department of Veterans Affairs Health Care System, Decatur, Georgia

    Jeann L. Sabino-Carvalho, Jinhee Jeong, Dana DaCosta & Jeanie Park

  3. Department of Kinesiology, Health Promotion and Recreation, University of North Texas, Denton, TX, USA

    Justin Sprick

  4. Human Cardiovascular Physiology Laboratory, Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, ON, Canada

    Massimo Nardone

Authors
  1. Jeann L. Sabino-Carvalho
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  4. Dana DaCosta
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Correspondence to Jeanie Park.

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Sabino-Carvalho, J.L., Jeong, J., Sprick, J. et al. Augmented resting beat-to-beat blood pressure variability in patients with chronic kidney disease. Clin Auton Res 33, 705–714 (2023). https://doi.org/10.1007/s10286-023-00979-1

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  • DOI: https://doi.org/10.1007/s10286-023-00979-1

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