Objective: Increased BP-variability predicts cardiovascular morbidity and mortality in hypertensives. This study aimed to examine short-term BP-variability according to renal function stage. Methods: We included 16 546 patients [10 270 (62.1%) without/6276 (38.9%) with CKD Stage 1–5] from the Spanish Ambulatory-Blood-Pressure Monitoring (ABPM) Registry. Stages of CKD were defined according to K/DIGO criteria, based on estimated glomerular filtration rate calculated with the CKD-EPI equation and albumin-to-creatine ratio. BP-variability was assessed with standard deviation (SD), weighted SD (wSD), coefficient of variation (CV), and average real variability (ARV). Results: Compared with those without CKD, a lower proportion of CKD patients were dippers (51.9 versus 39.6%; P < 0.001). Across CKD stages, a progressive decrease in dipper (from 39.1 to 20.4%; P < 0.001) and increase in riser proportion (from 12.3 to 36.7%; P < 0.001) were noted. Patients with CKD had significantly higher SBP SD, wSD, CV and ARV and lower DBP SD compared with those without CKD (P < 0.001). Within CKD Stages, an increasing trend from Stage 1 towards Stage 5 was observed for SBP SD (from 13.8 ± 3.7 to 15.6 ± 5.4 mmHg), wSD (from 12.0 ± 3.2 to 13.9 ± 5.1 mmHg), CV (from 10.4 ± 2.7 to 11.5 ± 4.1%), ARV (from 9.9 ± 2.3 to 11.4 ± 3.2 mmHg); P < 0.001 for all comparisons. DBP SD (P < 0.001), wSD and ARV (P = 0.002) were slightly decreasing, whereas DBP CV increased from Stage 1 to Stage 4 (P < 0.001). In multivariate analysis, male gender, older age, abdominal obesity, diabetes, number of antihypertensive medications, and clinic SBP were independent factors for higher SBP 24-h ARV in CKD. Conclusion: An increase in short-term SBP-variability was present with advancing CKD stages in a large cohort. This increased SBP-variability may be involved in the sharp elevation of cardiovascular risk with worsening renal function.

To examine the evolution of hypertension management and blood pressure (BP) control in Spain in the last decade across PRESCAP 2002, 2006 and 2010. The methodology of the three studies was the same. They were multicenter and cross-sectional surveys aimed to determine BP control rates in hypertensive patients in primary care in Spain during 2002, 2006 and 2010, respectively. In each study, patients at least 18 years, with an established diagnosis of hypertension were included. Adequate BP control was defined as BP less than 140/90 mmHg in the general population (<130/85 mmHg in PRESCAP 2002 and less than 130/80 mmHg in PRESCAP 2006 and PRESCAP 2010 for patients with diabetes, chronic kidney disease and cardiovascular disease). A total of 12,754 patients (mean age 63.3 ± 10.8 years; 57.2% women), 10,520 patients (64.6 ± 11.3 years; 53.7% women) and 12,961 patients (66.3 ± 11.4; 52.0% women) were included in PRESCAP 2002, PRESCAP 2006 and PRESCAP 2010 studies respectively. With regard to BP control rates, 36.1% [95% confidence interval (CI) 35.2-36.9%], 41.4% (95% CI 40.5-42.4%) and 46.3% of patients (95% CI 45.4-47.1%) achieved BP goals in PRESCAP 2002, PRESCAP 2006 and PRESCAP 2010, respectively (P < 0.0001). In PRESCAP 2002, 56% of patients were on monotherapy, 35.6% were taking two drugs and 8.4% at least three drugs. In PRESCAP 2006 these numbers were 44.4, 41.1 and 14.5%, respectively, and in PRESCAP 2010 they were 36.4, 44.1 and 19.5%, respectively (P < 0.0001). BP control rates have improved in Spain from 2002 to 2010. This may be related, at least in part, with the higher use of antihypertensive treatment, particularly combined therapy.