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

Authors
 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 
Citation
 Medicine, Vol.96(26) : e7380, 2017 
Journal Title
 Medicine 
ISSN
 0025-7974 
Issue Date
2017
MeSH
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
Abstract
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.
Files in This Item:
T201702048.pdf Download
DOI
10.1097/MD.0000000000007380
Appears in Collections:
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
김범석(Kim, Beom Seok) ORCID logo https://orcid.org/0000-0002-5732-2583
김현창(Kim, Hyeon Chang) ORCID logo https://orcid.org/0000-0001-7867-1240
박성하(Park, Sung Ha) ORCID logo https://orcid.org/0000-0001-5362-478X
박형천(Park, Hyeong Cheon) ORCID logo https://orcid.org/0000-0002-1550-0812
이정은(Lee, Jung Eun) ORCID logo https://orcid.org/0000-0003-0917-2872
장혁재(Chang, Hyuck Jae) ORCID logo https://orcid.org/0000-0002-6139-7545
최훈영(Choi, Hoon Young) ORCID logo https://orcid.org/0000-0002-4245-0339
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160302
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