NDT Advance Access published online on July 16, 2008
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfn383
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Stepwise increase in the prevalence of isolated systolic hypertension with the stages of chronic kidney disease
1 Division of Nephrology, Peking University Third Hospital, Beijing 2 Division of Cardiology, the Second Clinical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
Correspondence and offprint requests to: Li-Tao Cheng, Division of Nephrology, Peking University Third Hospital, 49 North Garden Rd, Haidian District, Beijing 100083, China. Tel: +86-10-62017691 Ext. 3296; Fax: +86-10-62017691 Ext. -2517; E-mail: ltcheng{at}bjmu.edu.cn
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Abstract |
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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.
Keywords: chronic kidney disease; hypertension; isolated diastolic hypertension; isolated systolic hypertension; systolic–diastolic hypertension
Received for publication: 27. 3.08
Accepted in revised form: 16. 6.08
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