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19 In settings, such as the UK or the Netherlands, where guidelines exist for specialist referral,20 21 there is substantial enrichment in specialist service populations for advanced CKD stage, rapidly declining renal function, or significant proteinuria. Observational studies of these groups for prognostic factors has an uncertain generalisability to the much larger, but less severely affected, population monitored predominantly by non-specialists DDR1 or primary care physicians. Furthermore, none of the previous studies of renal disease have used metrics of BP variability that have been shown to be independent of mean BP, and so, do not clearly distinguish between the effects of raised systolic BP and BP variability. The results of the regression analyses showed a consistent positive relationship between the presence of cardiovascular disease and BP variability, a finding that is consistent with the known prognostic significance of BP variability.22 Importantly, the time interval between BP measures was positively associated with BP variability, indicating that longer durations between measures were associated with greater variability. This counters the hypothesis that associations between greater BP variability and reduced renal function are an artefact of acute illness where clinical monitoring will be more frequent, or due to increased monitoring at the time of initiation of antihypertensive drugs. If acute illness or the initiation of antihypertensive Cilengitide therapy was responsible Selinexor manufacturer for increasing BP variability, one would expect greater variability to be associated with shorter time intervals between BP measures in a period of clinical instability or medication change. We presented standardised coefficients for all included variables in order to facilitate a clear clinical interpretation of the relative contributions of the predictors of the BP variability measures. A limited post hoc analysis of around 2000 patients selected for the ASCOT-BPLA trial showed a weak relationship between blood creatinine and BP variability, but the trial design undermines the generalisability of this analysis to representative patient populations.22 The study excluded anyone with a creatinine of >200??mol/L (2.26?mg/dL), with clinically important renal disease, with secondary hypertension (which could include renal disease), or any concomitant disease requiring calcium channel blockers, angiotensin converting enzyme inhibitors, �� blockers, or diuretics. These criteria would likely exclude the majority of patients with chronic kidney disease. Further, the study excluded anyone
