AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Office versus 48 Hour Ambulatory Derived Blood Pressure Parameters as Prospective Predictors of Cardiovascular and Renal Events in Patients with Advanced Chronic Kidney Disease
By El-Toukhy S, Hermida R, Smolensky M
Introduction: Clinical guidelines recommend ambulatory blood pressure (BP) monitoring (ABPM) to diagnose hypertension and assess chronic kidney disease (CKD) progression and cardiovascular disease (CVD) risk. Hypothesis: ABPM-derived asleep systolic BP (SBP) mean and/or sleep-time relative SBP decline towards the non-dipper/riser 24-hr SBP pattern are significant markers of a study endpoint among enrollees in the Sleep-Time Blood Pressure and Chronic Kidney Disease Progression Study. The study endpoint was combined outcome of progression towards end-stage kidney disease (ESKD) or a major CVD event (CVD death, myocardial infarction, coronary revascularization, heart failure, vascular surgery for peripheral artery disease, ischemic stroke, hemorrhagic stroke). Methods: At enrollment and every 3 months, office BP and 48-hour ABPM, with a sleep diary, was conducted to derive 48-hr, awake and asleep systolic and diastolic BP (SBP, DBP), and their sleep-time relative decline ([awake mean - asleep mean]/awake mean x100). Cox survival analysis modeled final office BP and ABPM parameters that preceded having a study endpoint as predictors of study endpoint. Results: The cohort was 180 adult men and women with moderate (CKD stage G3b, n= 80) to severe (CKD stage G4, n= 100) decreased glomerular filtration rate. Enrollees were elderly (mean age 70±11.1), male (66.7%), with less than high school education (60.6%) who were followed for a median of 2.31 years. Sixty-five enrollees progressed toward ESKD or had a major CVD event. Analyses supported study hypothesis. Models showed that 1 SD elevation in SBP asleep mean (Hazard ratio [HR] 1.45, 95%CI 1.17, 1.79) was associated with higher hazards of having a study endpoint, while 1 SD elevation in SBP sleep-time relative decline, indicating an increase in SBP dipping, was associated with lower hazards (HR 0.74, 95%CI 0.59, 0.93). Adjusting for SBP asleep mean, SBP 48-hr and SBP awake means were not significantly associated with study endpoint. Office SBP and DBP were not associated with study endpoint in the unadjusted nor adjusted models. Conclusion: ABPM-derived parameters were predictive of renal or CVD risk with SBP asleep mean being the most relevant. ABPM should be periodically assessed in CKD patients to capture these risk biomarkers and inform individualized therapeutic schemes. Funding: Research reported in this abstract was supported through The National Institutes of Health Bench-to-Bedside award made possible by The National Institute on Minority Health and Health Disparities. Disclaimer: This work was supported by the Intramural Research Program of the National Institutes of Health (NIH). The contributions of the NIH authors are considered Works of the United States Government. The findings and conclusions presented in this paper are those of the authors and do not reflect the views of the NIH or US Department of Health and Human Services.