Zhuang, Y, Ding, C, Xu, Y, Ding, Z and Yu, D ORCID: https://orcid.org/0000-0002-8449-7725 (2020) Association between long-term pulse pressure trajectories and risk of end-stage renal diseases in incident malignant hypertensive nephropathy. Blood Pressure Monitoring, Publis.

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Abstract

Objective
The trajectories of pulse pressure (PP) might affect the prognosis of malignant hypertensive nephropathy (MHN). We aimed to describe the association between PP trajectories and the future risk of end-stage renal disease and to identify and compare the associated patient characteristics of any distinct trajectory patterns in MHN patients.

Methods
Patients with newly diagnosed biopsy-proven MHN 2010–2015 were included. Latent class growth analysis was applied to the PP measured over 3 years prior to biopsy to identify distinct trajectories. Concurrent systolic blood pressure, diastolic blood pressure, plasma creatinine, and 24-h urine protein measurements for each trajectory group were modelled using generalized estimating equations. The risk of end-stage renal disease (with kidney replacement therapy as a proxy) was estimated using Logistic regression.

Results
Two hundred three patients were included (median-age 34 years, and 19.7% female). A two-group cubic model was optimal, with trajectories distinguished by the rate of PP and absolute level at final measurement. Trajectory Group-1 (n = 84) was characterized by ‘first-increased-then-decreased’ PP and trajectory Group-2 (n = 119) was characterized by ‘first-decreased-then-increased’ PP over 3 years prior to biopsy. Systolic and diastolic blood pressures, plasma creatinine, and 24-h urine protein were differed by the trajectory group. Baseline characteristics differed substantially between trajectory groups. Compared with Group-1, Group-2 had a 66% greater risk of developing into end-stage renal disease in the subsequent 3 years.

Conclusions
Two distinct 3-year trajectories for PP exist with MHN. Early introduction of intensive antihypertensive treatment might delay the development of end-stage renal disease among patients with malignant hypertension.

Item Type: Article
Additional Information: The final version of this article and all relevant information can be found at; https://journals.lww.com/bpmonitoring/Abstract/9000/Association_between_long_term_pulse_pressure.99356.aspx
Uncontrolled Keywords: malignant hypertension, pulse pressure, trajectory
Subjects: R Medicine > R Medicine (General)
R Medicine > R Medicine (General) > R735 Medical education. Medical schools. Research
R Medicine > RC Internal medicine
R Medicine > RC Internal medicine > RC902 Nephrology
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 06 Aug 2020 14:14
Last Modified: 06 Aug 2020 14:14
URI: https://eprints.keele.ac.uk/id/eprint/8487

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