Acknowledging the Impact of Seasonal Blood Pressure Variation in Hypertensive CKD and Non-CKD Patients Living in a Mediterranean Climate

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2023 Dec 7

PMID 38060575

Authors

Tatiana Charbel

Georgio El Koubayati

Chloe Kharsa

Mabel Aoun

Affiliations

Soon will be listed here.

Abstract

Background: This study aims to assess seasonal blood pressure (BP) variation in chronic kidney disease (CKD) and non-CKD patients living in a Mediterranean climate, and to find out if this variation entails significant adjustment of treatment and if it impacts renal outcomes and mortality.

Methods: This retrospective study included all hypertensive patients seen between February 2006 and April 2020 in two Lebanese clinics. Regression analyses were used to assess the association of seasonal BP variability and treatment adjustment with eGFR change from baseline, dialysis initiation and death.

Results: A total of 398 patients of 64.2 ±13.9 years were followed for 51.1 ±44.3 months, 67% had eGFR< 60 mL/min. Mean systolic and diastolic BP was 137.7 ±14.7 and 76.5 ±9.5 mmHg respectively. Systolic and diastolic BP were significantly lower in the warm season in CKD and non-CKD patients (P<0.001). The majority (91.4%) needed seasonal treatment modifications. After adjustment to age, sex, baseline eGFR, BP and number of antihypertensive drugs, we found a significant loss of eGFR with treatment modifications in both seasons, double risk of dialysis with the increase of antihypertensive treatment in both seasons and a 2.5 more risk of death with reduced treatment in the warm season.

Conclusion: This study confirmed the seasonal BP variability in CKD and non-CKD patients from a Mediterranean climate. All types of treatment adjustment were associated with eGFR loss. Low BP in the warm season was highly associated with death.

References

Emmons-Bell S, Johnson C, Roth G . Prevalence, incidence and survival of heart failure: a systematic review. Heart. 2022; 108(17):1351-1360. PMC: 9380485. DOI: 10.1136/heartjnl-2021-320131. View

Chang A, Loser M, Malhotra R, Appel L . Blood Pressure Goals in Patients with CKD: A Review of Evidence and Guidelines. Clin J Am Soc Nephrol. 2018; 14(1):161-169. PMC: 6364532. DOI: 10.2215/CJN.07440618. View

. Chapter 1: Definition and classification of CKD. Kidney Int Suppl (2011). 2014; 3(1):19-62. PMC: 4089693. DOI: 10.1038/kisup.2012.64. View

Sega R, Cesana G, Bombelli M, Grassi G, Stella M, Zanchetti A . Seasonal variations in home and ambulatory blood pressure in the PAMELA population. Pressione Arteriose Monitorate E Loro Associazioni. J Hypertens. 1998; 16(11):1585-92. DOI: 10.1097/00004872-199816110-00004. View

Park S, Kario K, Chia Y, Turana Y, Chen C, Buranakitjaroen P . The influence of the ambient temperature on blood pressure and how it will affect the epidemiology of hypertension in Asia. J Clin Hypertens (Greenwich). 2019; 22(3):438-444. PMC: 8029770. DOI: 10.1111/jch.13762. View

Farrell M, Shibao C . Morbidity and mortality in orthostatic hypotension. Auton Neurosci. 2020; 229:102717. DOI: 10.1016/j.autneu.2020.102717. View

See C, Tseng C, Lin W, Chao J, Kuo T, Wang M . Seasonal Change in Home Blood Pressure Monitoring Is Associated With Renal Outcome and Mortality in Patients With Chronic Kidney Disease. Front Med (Lausanne). 2021; 8:672651. PMC: 8192714. DOI: 10.3389/fmed.2021.672651. View

Adamczak M, Surma S, Wiecek A . Vitamin D and Arterial Hypertension: Facts and Myths. Curr Hypertens Rep. 2020; 22(8):57. DOI: 10.1007/s11906-020-01059-9. View

Mills K, Stefanescu A, He J . The global epidemiology of hypertension. Nat Rev Nephrol. 2020; 16(4):223-237. PMC: 7998524. DOI: 10.1038/s41581-019-0244-2. View

10.

Whelton P, Carey R, Aronow W, Casey Jr D, Collins K, Himmelfarb C . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on.... Hypertension. 2017; 71(6):e13-e115. DOI: 10.1161/HYP.0000000000000065. View

11.

Tozawa M, Iseki K, Iseki C, Kinjo K, Ikemiya Y, Takishita S . Blood pressure predicts risk of developing end-stage renal disease in men and women. Hypertension. 2003; 41(6):1341-5. DOI: 10.1161/01.HYP.0000069699.92349.8C. View

12.

Abrignani M, Lombardo A, Braschi A, Renda N, Abrignani V . Climatic influences on cardiovascular diseases. World J Cardiol. 2022; 14(3):152-169. PMC: 8968453. DOI: 10.4330/wjc.v14.i3.152. View

13.

Lewington S, Li L, Sherliker P, Guo Y, Millwood I, Bian Z . Seasonal variation in blood pressure and its relationship with outdoor temperature in 10 diverse regions of China: the China Kadoorie Biobank. J Hypertens. 2012; 30(7):1383-91. PMC: 4344838. DOI: 10.1097/HJH.0b013e32835465b5. View

14.

Alahmad B, Khraishah H, Roye D, Vicedo-Cabrera A, Guo Y, Papatheodorou S . Associations Between Extreme Temperatures and Cardiovascular Cause-Specific Mortality: Results From 27 Countries. Circulation. 2022; 147(1):35-46. PMC: 9794133. DOI: 10.1161/CIRCULATIONAHA.122.061832. View

15.

Yang L, Li J, Wei W, Pu Y, Zhang L, Cui T . Blood Pressure Variability and the Progression of Chronic Kidney Disease: a Systematic Review and Meta-Analysis. J Gen Intern Med. 2023; 38(5):1272-1281. PMC: 10110830. DOI: 10.1007/s11606-022-08001-6. View

16.

Sinha P, Kumar T, Singh N, Saha R . Seasonal variation of blood pressure in normotensive females aged 18 to 40 years in an urban slum of Delhi, India. Asia Pac J Public Health. 2009; 22(1):134-45. DOI: 10.1177/1010539509351190. View

17.

Chia Y, Lim H, Ching S . Long-Term Visit-to-Visit Blood Pressure Variability and Renal Function Decline in Patients With Hypertension Over 15 Years. J Am Heart Assoc. 2016; 5(11). PMC: 5210361. DOI: 10.1161/JAHA.116.003825. View

18.

Pugh D, Gallacher P, Dhaun N . Management of Hypertension in Chronic Kidney Disease. Drugs. 2019; 79(4):365-379. PMC: 6422950. DOI: 10.1007/s40265-019-1064-1. View

19.

Horowitz B, Miskulin D, Zager P . Epidemiology of hypertension in CKD. Adv Chronic Kidney Dis. 2015; 22(2):88-95. DOI: 10.1053/j.ackd.2014.09.004. View

20.

Rothwell P, Howard S, Dolan E, OBrien E, Dobson J, Dahlof B . Prognostic significance of visit-to-visit variability, maximum systolic blood pressure, and episodic hypertension. Lancet. 2010; 375(9718):895-905. DOI: 10.1016/S0140-6736(10)60308-X. View