Blood Pressure Dipping Status in Chronic Kidney Disease and Association With Adverse Outcomes: A Systematic Review and Meta-Analysis.
Sara Abdallah, Ghaidaa El Saddik, Sola Aoun Bahous et al.
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In 30 seconds
This systematic review and random-effects meta-analysis examined nondipping blood pressure prevalence, its association with CKD, and outcomes among people with CKD. It included 63 articles covering 54 515 patients, including 33 825 with CKD. Nondipping—less than 10% nighttime blood pressure reduction—was present in 0.53 (95% CI, 0.52-0.53) of patients with CKD. Among those with CKD, dippers had lower relative risks of mortality, cardiovascular events, and CKD progression than nondippers; for mortality, RR was 0.60 (95% CI, 0.49-0.72).
Key findings
- Nondipping prevalence in CKD was 0.53 (95% CI, 0.52-0.53).
- Compared with patients with CKD, those without CKD had lower risk of nondipping (RR, 0.69 [95% CI, 0.63-0.75], P <0.001).
- Among patients with CKD, dippers had lower mortality than nondippers (RR, 0.60 [95% CI, 0.49-0.72], P <0.001).
- Dipping was associated with lower risks of cardiovascular events (RR, 0.63 [95% CI, 0.47-0.85]) and CKD progression (RR, 0.64 [95% CI 0.55-0.75]).
Why it matters
The findings indicate that nondipping is common in CKD and is associated with clinically important outcomes, including mortality, cardiovascular events, and disease progression. Blood pressure patterns across day and night may therefore provide useful prognostic information in this population, although the evidence describes associations rather than demonstrating that changing dipping status improves outcomes.
What to keep in mind
Almost all included studies were retrospective cohorts, and the review reported high heterogeneity.