TY - JOUR
T1 - Association of 24-hour ambulatory blood pressure patterns with cognitive function and physical functioning in CKD
AU - CRIC Study Investigators
AU - Ghazi, Lama
AU - Yaffe, Kristine
AU - Tamura, Manjula K.
AU - Rahman, Mahboob
AU - Hsu, Chi yuan
AU - Anderson, Amanda H.
AU - Cohen, Jordana B.
AU - Fischer, Michael J.
AU - Miller, Edgar R.
AU - Navaneethan, Sankar D.
AU - He, Jiang
AU - Weir, Matthew R.
AU - Townsend, Raymond R.
AU - Cohen, Debbie L.
AU - Feldman, Harold I.
AU - Drawz, Paul E.
AU - Appel, Lawrence J.
AU - Go, Alan S.
AU - Lash, James P.
AU - Rao, Panduranga
N1 - Publisher Copyright:
© 2020 by the American Society of Nephrology.
PY - 2020/4/7
Y1 - 2020/4/7
N2 - Background and objectives Hypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysisdependent CKD. Design, setting, participants, & measurements Ambulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: (1) BP patterns (white coat, masked, sustained versus controlled hypertension) and (2) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: (1) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65-79, and ≥80 years, respectively; (2) physical function, measured by the short physical performance battery (SPPB), with higher scores (0-12) indicating better functioning; and (3) frailty, measured bymeeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes. Results Mean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB scorewas 9 (interquartile range, 7-10). At baseline, participants with masked hypertension had 0.41 (95% CI, -0.78 to -0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment. Conclusions In patients with CKD, dipping andBP patterns are not associatedwith incident or prevalent cognitive impairment or prevalent frailty.
AB - Background and objectives Hypertension is highly prevalent in patients with CKD as is cognitive impairment and frailty, but the link between them is understudied. Our objective was to determine the association between ambulatory BP patterns, cognitive function, physical function, and frailty among patients with nondialysisdependent CKD. Design, setting, participants, & measurements Ambulatory BP readings were obtained on 1502 participants of the Chronic Renal Insufficiency Cohort. We evaluated the following exposures: (1) BP patterns (white coat, masked, sustained versus controlled hypertension) and (2) dipping patterns (reverse, extreme, nondippers versus normal dippers). Outcomes included the following: (1) cognitive impairment scores from the Modified Mini Mental Status Examination of <85, <80, and <75 for participants <65, 65-79, and ≥80 years, respectively; (2) physical function, measured by the short physical performance battery (SPPB), with higher scores (0-12) indicating better functioning; and (3) frailty, measured bymeeting three or more of the following criteria: slow gait speed, muscle weakness, low physical activity, exhaustion, and unintentional weight loss. Cognitive function and frailty were assessed at the time of ambulatory BP (baseline) and annually thereafter. SPPB was assessed at baseline logistic and linear regression and Cox discrete models assessed the cross-sectional and longitudinal relationship between dipping and BP patterns and outcomes. Results Mean age of participants was 63±10 years, 56% were male, and 39% were black. At baseline, 129 participants had cognitive impairment, and 275 were frail. Median SPPB scorewas 9 (interquartile range, 7-10). At baseline, participants with masked hypertension had 0.41 (95% CI, -0.78 to -0.05) lower SPPB scores compared with those with controlled hypertension in the fully adjusted model. Over 4 years of follow-up, 529 participants had incident frailty, and 207 had incident cognitive impairment. After multivariable adjustment, there was no association between BP or dipping patterns and incident frailty or cognitive impairment. Conclusions In patients with CKD, dipping andBP patterns are not associatedwith incident or prevalent cognitive impairment or prevalent frailty.
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U2 - 10.2215/CJN.10570919
DO - 10.2215/CJN.10570919
M3 - Article
C2 - 32217634
AN - SCOPUS:85083003424
SN - 1555-9041
VL - 15
SP - 452
EP - 464
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 4
ER -