Stepwise increase in the prevalence of isolated systolic hypertension with the stages of chronic kidney disease

Abstract

Background. Hypertension is common in patients with chronic kidney disease (CKD), and isolated systolic hypertension (ISH) accounts for most patients with inadequate blood pressure (BP) control. However, it remains unclear whether the prevalence of ISH would increase with the advancement of CKD. Methods. CKD patients of stages 3, 4 and 5 were recruited (n = 324). Based on office systolic BP (SBP) and diastolic BP (DBP), they were classified into any of the four hypertensive subtypes: normotension (SBP/DBP < 140/90 mmHg), isolated diastolic hypertension (IDH, SBP < 140 mmHg and DBP >= 90 mmHg), ISH (SBP >= 140 mmHg and DBP < 90 mmHg) and systolic-diastolic hypertension (SDH, SBP/DBP >= 140/90 mmHg). Results. The control rate was 45.7% at stage 3, which decreased with the advancement of CKD (control rate was 51.9%, 40.4% and 38.6% in stage 3, 4 and 5, respectively; P < 0.05). The prevalence of IDH changed from 5.0% to 5.3% and 0% from stage 3 to 4 and 5, while there was no significant change in the prevalence of SDH (15.0%, 14.9% and 15.7% at stage 3, 4 and 5, respectively). There was a stepwise increase in the prevalence of ISH with the stages of CKD (it was 28.1%, 39.4% and 45.7% in stage 3, 4 and 5, respectively). Logistic regression showed that age and CKD stages [compared with stage 3, stage 4 and 5 had 2.57 (95% CI 1.04-6.33) and 3.68 (95% CI 1.09-12.47) folds higher risk to develop ISH, respectively] were independent predictors of ISH. Conclusion. The prevalence of ISH increased correspondingly with advanced stages of CKD, which may partially contribute to the increased cardiovascular mortality during the progress of CKD.