ABSTRACT
Long-term visit-to-visit blood pressure (BP) variability predicts a high risk for cardiovascular events in patients with essential hypertension. Whether long-term visit-to-visit BP variability holds the same predictive power in predialysis patients with chronic kidney disease (CKD) is unknown. Here we tested the relationship between long-term visit-to-visit office BP variability and a composite end point (death and incident cardiovascular events) in a cohort of 1618 patients with stage 2-5 CKD. Visit-to-visit systolic BP variability was significantly and independently related to baseline office, maximal, and average systolic BPs, age, glucose, estimated glomerular filtration rate, and albumin, and to the number of visits during the follow-up. Both the standard deviation of systolic BP (hazard ratio: 1.11, 95% confidence interval: 1.01-1.20) and the coefficient of variation of systolic BP (hazard ratio: 1.15, 95% confidence interval: 1.02-1.29) were significant predictors of the combined end point independent of peak and average systolic BP, cardiovascular comorbidities, Framingham risk factors, and CKD-related risk factors. Antihypertensive treatment (ß-blockers and sympatholytic drugs) significantly abrogated the excess risk associated with high systolic BP variability. Thus, large visit-to-visit systolic BP variability in patients with CKD predicts a higher risk of death and nonfatal cardiovascular events independent of underlying BP levels.
Subject(s)
Blood Pressure Determination/methods , Blood Pressure , Hypertension/diagnosis , Office Visits , Renal Insufficiency, Chronic/diagnosis , Aged , Antihypertensive Agents/therapeutic use , Blood Pressure/drug effects , Chi-Square Distribution , Comorbidity , Female , Glomerular Filtration Rate , Humans , Hypertension/drug therapy , Hypertension/mortality , Hypertension/physiopathology , Incidence , Italy , Kidney/physiopathology , Linear Models , Male , Middle Aged , Multivariate Analysis , Predictive Value of Tests , Prognosis , Proportional Hazards Models , Renal Insufficiency, Chronic/mortality , Renal Insufficiency, Chronic/physiopathology , Risk Factors , Time FactorsABSTRACT
The education level of women has increased significantly in recent decades. However, although there is a continued positive trend overall, women remain underrepresented (or misrepresented?) in the main fields of science. In Europe the proportion of women in scientific research is growing faster than that of men, but women are more likely than men to choose education, arts and humanities, health and welfare. Moreover, of the total number of women graduating in all faculties (55%), the percentage of women graduating in medicine is 65%-68%, in Europe as in the United States. As far as nephrology is concerned, unpublished data from the Italian Society of Nephrology indicate that female nephrologists make up almost 30% of the total number in the age group between 40 and 55, and this proportion is even higher in the age group younger than 40 years. In comparison with the past, there are some hints that things are going to change, but the path is still a difficult one, much effort is needed and there is a long way ahead.
