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Loss of nighttime blood pressure dipping as a risk factor for coronary artery calcification in nondialysis chronic kidney disease

 Hoon Young Choi  ;  Chan Joo Lee  ;  Jung Eun Lee  ;  Hyun Su Yang  ;  Ha Yan Kim  ;  Hyeong Cheon Park  ;  Hyeon Chang Kim  ;  Hyuk-Jae Chang  ;  Sung-Ha Park  ;  Beom Seok Kim 
 MEDICINE, Vol.96(26) : e7380, 2017 
Journal Title
Issue Date
Aged ; Blood Pressure ; Blood Pressure Monitoring, Ambulatory ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/epidemiology ; Coronary Artery Disease/physiopathology ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/physiopathology ; Electrocardiography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Photoperiod ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/diagnostic imaging ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/physiopathology ; Risk Factors ; Tomography, X-Ray Computed ; Vascular Calcification/complications ; Vascular Calcification/diagnostic imaging ; Vascular Calcification/epidemiolog ; Vascular Calcification/physiopathology
Diurnal variations in blood pressure (BP) loss are closely associated with target organ damage and cardiovascular events. The quantity of coronary artery calcification (CAC) correlates with the atherosclerotic plaque burden, and an increased quantity indicates a substantially increased risk of cardiovascular events. This study investigated the nighttime diurnal variation in BP loss associated with CAC in patients with chronic kidney disease (CKD).Of the 1958 participants, we enrolled 722 participants with CKD without a history of acute coronary syndrome or symptomatic coronary artery disease. CAC was measured with computed tomography. BP was measured using 24-hour ambulatory BP monitoring. Central BP was measured using a SphygmoCor waveform analysis system.Participants with CAC had significantly higher 24-hour systolic, daytime systolic, and nighttime systolic ambulatory BP and central systolic BP. The percentage of participants with dipping loss was significantly higher among those with CAC. Multivariate logistic regression analysis indicated that dipping loss and dipping ratio were independently associated with CAC after adjusting for traditional and nontraditional cardiovascular risk factors and other BP parameters, including measurements of office-measured BP and central BP. The dipping status improved risk prediction for CAC after considering traditional risk factors and office-measured BP, using the net reclassification improvement and integrated discrimination improvement.Nighttime loss of diurnal variation in BP is an independent risk factor for CAC in CKD patients.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Preventive Medicine and Public Health (예방의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Beom Seok(김범석) ORCID logo https://orcid.org/0000-0002-5732-2583
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
Lee, Jung Eun(이정은) ORCID logo https://orcid.org/0000-0003-0917-2872
Chang, Hyuk-Jae(장혁재) ORCID logo https://orcid.org/0000-0002-6139-7545
Choi, Hoon Young(최훈영) ORCID logo https://orcid.org/0000-0002-4245-0339
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