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Differential effects of arterial stiffness and fluid overload on blood pressure according to renal function in patients at risk for cardiovascular disease

 Seohyun Park  ;  Chan Joo Lee  ;  Misol Lee  ;  Min-Uk Cha  ;  Seong Yeong An  ;  Ki Heon Nam  ;  Jong Hyun Jhee  ;  Hae-Ryong Yun  ;  Hyoungnae Kim  ;  Youn Kyung Kee  ;  Jung Tak Park  ;  Hyeon Chang Kim  ;  Tae-Hyun Yoo  ;  Shin-Wook Kang  ;  Sungha Park  ;  Seung Hyeok Han 
 HYPERTENSION RESEARCH, Vol.42(3) : 341-353, 2019 
Journal Title
Issue Date
blood pressure ; chronic kidney disease ; fluid overload
The pathogenesis of hypertension is multifactorial in patients with chronic kidney disease (CKD). We explored the relative contribution of arterial stiffness and fluid overload to blood pressure (BP) in these patients. We evaluated 1531 patients from a prospective observational cohort study of high-risk patients with cardiovascular disease. BP, arterial stiffness, and volume status expressed as the extracellular water/total body water ratio (ECW/TBW) were measured by 24-h BP monitoring, pulse-wave velocity (PWV), and bioelectrical impedance analysis, respectively. Multiple linear regression analysis showed that both PWV and ECW/TBW of the patients with CKD were significantly associated with 24-h systolic BP (SBP). The areas under the receiver-operating characteristic curve (AUCs) for predicting 24-h SBP ≥130 mm Hg significantly increased after PWV was added to conventional factors regardless of CKD status. However, the AUCs did not increase in the ECW/TBW-based models. When a cut-off 24-h SBP level of 140 mm Hg was used, the predictability of ECW/TBW for elevated BP significantly improved in patients with CKD (0.718 vs. 0.683, P = 0.034) but not in those without. Notably, a significant impact of arterial stiffness on high BP was consistently observed regardless of CKD status. This association was further confirmed by the net reclassification and integrated discriminant improvements, root mean squared error with adjusted R2, and interaction effects. As kidney function declines, fluid overload is significantly associated with high BP. The impact of fluid overload on BP is only observed in more severe hypertension in patients with CKD.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Shin Wook(강신욱) ORCID logo https://orcid.org/0000-0002-5677-4756
Kim, Hyeon Chang(김현창) ORCID logo https://orcid.org/0000-0001-7867-1240
Nam, Ki Heon(남기헌) ORCID logo https://orcid.org/0000-0001-7312-7027
Park, Seo Hyun(박서현)
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Park, Jung Tak(박정탁) ORCID logo https://orcid.org/0000-0002-2325-8982
An, Seong Yeong(안성영)
Yun, Hae Ryong(윤해룡) ORCID logo https://orcid.org/0000-0002-7038-0251
Lee, Mi Sol(이미솔)
Jhee, Jong Hyun(지종현)
Cha, Min Uk(차민욱)
Han, Seung Hyeok(한승혁) ORCID logo https://orcid.org/0000-0001-7923-5635
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