Reproducibility of Ambulatory Blood Pressure Monitoring in Autosomal Dominant Polycystic Kidney Disease Open Access

Rahbari Oskoui, Frederic (2010)

Permanent URL: https://etd.library.emory.edu/concern/etds/00000070p?locale=en
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Abstract


Abstract


Reproducibility of Ambulatory Blood Pressure monitoring (ABPM) in
Autosomal Dominant Polycystic Kidney Disease (ADPKD)

By Frederic F. Rahbari Oskoui, M.D.


Background: Non-dipping defined as less than 10% decline in night/day systolic (SBP) and
diastolic blood pressures (DBP) by 24 hour ABPM is associated with poor cardiovascular
outcomes in patients with essential hypertension. However, controversies on reproducibility
of dipping status have been raised in both essential hypertension and ADPKD. Therefore, we
established the short term reproducibility of ABPM in ADPKD.
Methods:
25 HALT-PKD trial participants with estimated glomerular filtration rate (eGFR)
> 25 ml/min underwent ABPM on two occasions, 7-15 days apart, after completion of
antihypertensive medication titration. Daytime was defined as 6:00-21:59 and night time as
22:00-6:00. Correlation and concordance coefficients for SBP, DBP, mean arterial pressure
(MAP), heart rate (HR) and pulse pressure (PP) were determined based on day/night
separation of the readings. Dipping was considered both as a dichotomous and continuous
variable. Cohen's Kappa statistics were used to compare the proportions of dippers and non-
dippers. Univariate analysis was performed to identify potential associations between dipping
status and various characteristics.

Results
: 29 patients were consented of whom 25 completed two acceptable ABPMs. Mean
(+SD) age was 43.12 (8.55) years, age of onset for HBP 33.6 (11.1) years, estimated GFR
63.1 (20.5) mL/min, BMI 26.6 (5.1) Kg/m2, baseline SBP and DBP were 129.6 (12.5) and
81.6 (6.5) mmHg. Mean (+SD) differences in daytime-nighttime blood pressures were
11.74(8.2) and 10.82 (6.4) mmHg for SBP and DBP respectively.17/25 subjects (68%) were
either consistently non-dippers (11/25 or 44%) or consistently dippers (6/25 or 24%). Two (8%)
were reverse-dippers. Eight (32%) changed their dipping status between two measurements.
The overall Cohen's Kappa statistic was 0.34 (SD=0.18). Correlation and concordance
coefficients were 0.881and 0.887 for daytime SBP, 0.862 and 0.882 for daytime DBP, 0.939-
0.897 for nighttime SBP and 0.932-0.887 for nighttime DBP respectively. No variables
associated with the magnitude or consistency of dipping.

Conclusion:
Repeated measures of SBP and DBP, 7-15 days apart, are highly correlative and
concordant in treated hypertensive ADPKD patients. Non-dipping is present in majority of
patients and is moderately reproducible in this population. Future research is warranted to
elucidate determinants of nocturnal dipping over a short period of time.

Table of Contents



Table of Contents



I- Introduction-Specific aim ………………................................................…………………………………….................. 1-3 II- Background and significance ………................................................……………………………………….................. 4-6 III- Methods …....................................................……………………………………………………………………..............7-13 Recruitment: ………………………………………………...................................................................…………….............................. 7-9 The HALT- PKD trial ………………………………..………............................................................................................................ 7 Recruitment goals …………………………………………..................... ........................................................................................ 8 Inclusion and Exclusion Criteria ……………………………........................................................................................................ 8 Human Subject Protection ………………………………….......................................................................................................... 9 ABPM procedures …………………………………………………...................................................................................................9-11 The Monitor …………………………………………………................................................................................................................ 9 ABPM set up and removal ........................................................................................................................................ 9 frequency of measurements ................................................................................................................................... 10 ABPM validation criteria ......................................................................................................................................... 10 Coordinator Training ………………………………………….......................................................................................................... 11 Database management ………………………………………......................................................................................................... 11 Statistical Methods ………………………………………………….......................................................................…......................11-13 Description of ABPM parameters ……………………………...................................................................................................... 11 Sample size and Study Power ………………………………....................................................................................................... 12 Data Analysis …………………………………………………............................................................................................................. 13 IV- Results …………………………………………………………………………................................................................ 14-15 V- Discussion ................................................................................................................................................ 16-19 VI- Conclusions .................................................................................................................................................. 20 VII- Tables ………………………………………………………………………................................................................... 21-27 Table-1: Comparison of OBPM, ABPM and HBPM in essential hypertension ......................................................................... 21 Table-2: Reproducibility of nocturnal blood pressure fall ................................................................................................ 22 Table-3: Baseline characteristics .............................................................................................................................. 23 Table-4: Comparison of blood pressure readings between Day-1 and Day-2....................................................................... 24 Table-5: Correlation and concordane coefficients etween day-1 and Day-2 for daytime and nighttime ................................... 25 Table-6: Dipping status, Day-1 and Day-2 .................................................................................................................. 26 Table-7: Univariate analysis evaluating consistency of dipping status at Day-1 and Day-2 and potential predictor variables ....... 27 VIII - Figures ………………………………………………………………………….............................................................. 28-30 Figure-1: Organizational structure of ABPM within HALT-PKD trial …………........................................................................... 28 Figure-2: Comparison of Blood pressure readings between day-1 and Day-2 ….................................................................... 29 Figure-3: Correlation between night:day ratio of SBP and DBP between Day-1 and Day-2 .................................................... 30 IX- References ............................................................................................................................................... 31-35 X - List of Abbreviation ………………………………………………………………............................................................ 36-37

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