All ETDs from UAB

Advisory Committee Chair

Paul Muntner

Advisory Committee Members

Orlando M GutiéRrez

Suzanne Oparil

Marguerite R Irvin

George Howard

Document Type

Dissertation

Date of Award

2014

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Kidney disease is common, with recent estimates indicating a prevalence of 13% among US adults. Furthermore, the vast majority of individuals with kidney disease have hypertension. Apparent treatment-resistant hypertension (aTRH), 24-hour blood pressure (BP) variability, and inter-arm differences (IADs) in BP have been identified as risk factors for cardiovascular disease, and there is increasing evidence that these phenotypes provide prognostic information above and beyond mean clinic BP. However, these phenotypes have not been extensively studied among individuals with kidney disease. The goal of this dissertation was to determine the association of kidney disease with BP phenotypes in the context of three studies, namely, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, the Jackson Heart Study, and the Hypertension Genetic Epidemiology Network (HyperGEN) study. We observed a high prevalence of aTRH in the REGARDS study and demonstrated that lower estimated glomerular filtration rate (eGFR), higher albumin-to-creatinine ratio (ACR), and lower eGFR and higher ACR considered jointly were associated with higher prevalence ratios for aTRH. Additionally, individuals with aTRH had a higher risk of developing ESRD than their counterparts without aTRH. Using data from the Jackson Heart Study, we found that kidney disease was associated with higher 24-hour BP variability, but the association was explained by the higher mean BP among those with kidney disease. Finally, through analysis of HyperGEN data, we identified small IADs in BP among participants with and without kidney disease. Notably, 18% of those with kidney disease had IADs in systolic BP in excess of 10 mmHg. In conclusion, this dissertation examines the association between unconventional BP phenotypes with kidney disease and identifies correlates of these phenotypes among individuals with kidney disease. Evaluating these phenotypes may help define the need for screening and their routine clinical evaluation among patients with kidney disease.

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