Association of 24-hour ambulatory blood pressure patterns with cognitive function and physical functioning in CKD

CRIC Study Investigators

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11 Scopus citations


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 nondialysis-dependent 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 by meeting 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 score was 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 and BP patterns are not associated with incident or prevalent cognitive impairment or prevalent frailty.

Original languageEnglish (US)
Pages (from-to)452-464
Number of pages10
JournalClinical Journal of the American Society of Nephrology
Issue number4
StatePublished - Apr 7 2020

Bibliographical note

Funding Information:
Dr. Hsu reports receiving consulting fees from EcoR1 Capital Fund, Health Advances, and Ice Miller LLP; BP devices from Mi-crolife; a grant from and a scientific advisory board position at Satellite Healthcare; and royalties from UptoDate, Inc.; all outside of the submitted work. Dr. Kurella Tamura reports consultant work for Alkahest. Dr. Navaneethan reports receiving event adjudication committee positions with Bayer and Boehringer Ingelheim and consultant fees from Reta Pharmacueticals and Tricida, outside of the submitted work. Dr. Townsend reports receiving consultant fees from Welch-Allyn. All remaining authors have nothing to disclose.

Funding Information:
Funding for the CRIC study was obtained under a cooperative agreement from the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, and U01DK060902). In addition, this study was supported, in part, by the Perelman School of Medicine, University of Pennsylvania Clinical and Translational Science Award, National Institutes of Health (NIH)/National Center for Advancing Translational Sciences (NCATS; UL1TR000003); Johns Hopkins University (UL1 TR000424); University of Maryland General Clinical Research Center (M01 RR-16500); Clinical and Translational Science Collaborative of Cleveland, School of Medicine, Case Western Reserve University from the NCATS component of the NIH and NIH Roadmap for Medical Research (UL1TR000439); Michigan Institute for Clinical and Health Research (UL1TR000433); Center for Clinical and Translational Science, University of Illinois at Chicago (UL1RR029879); Tulane Centers of Biomedical Research Excellence for Clinical and Translational Research in Cardiometabolic Diseases (P20 GM109036); and Kaiser Permanente, NIH/National Center for Research Resources, Clinical and Translational Science Institute, University of California, San Francisco (UL1 RR-024131).

Publisher Copyright:
© 2020 by the American Society of Nephrology.

PubMed: MeSH publication types

  • Research Support, Non-U.S. Gov't
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Multicenter Study
  • Observational Study


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