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
About this Master's Thesis
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