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The authors aimed to analyze the relationship between subclinical renal damage, defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30mL/min/1.73m(2) and 60mL/min/1.73m(2) and short-term blood pressure (BP) variability, assessed as average real variability (ARV), weighted standard deviation (SD) of 24-hour BP, and SD of daytime and nighttime BP. A total of 328 hypertensive patients underwent 24-hour ambulatory BP monitoring, 24-hour albumin excretion rate determination, and eGFR calculation using the Chronic Kidney Disease Epidemiology Collaboration equation. ARV of 24-hour systolic BP (SBP) was significantly higher in patients with subclinical renal damage (P=.001). This association held (P=.04) after adjustment for potential confounders. In patients with microalbuminuria, ARV of 24-hour SBP, weighted SD of 24-hour SBP, and SD of daytime SBP were also independently and inversely related to eGFR. These results seem to suggest that in essential hypertension, short-term BP variability is independently associated with early renal abnormalities.

Objective: Experimental studies documented that the mechanical injury of intravascular pressure on the vessel wall, which results in vascular remodelling and atherosclerosis, may be more closely associated to oscillatory than to steady laminar shear stress This suggests that the hypertensive patient's prognosis may depend not only on average BP level but also on the degree and rate of BP variation. Little is known about the relationships between early renal abnormalities and the rate of BP changes assessed by intermittent 24-h ambulatory BP monitoring (ABPM). Our study was aimed to analyse the relationships between subclinical renal damage (SRD), defined as the presence of microalbuminuria or an estimated glomerular filtration rate (eGFR) between 30-60 ml/min/1.73 m2 and the maximum speed of BP rise (Max Slope BP) during a 24-h BP recording Design and method: The study population consisted of 389 untreated essential hypertensives (mean age: 49 +/- 13 years; males 58%), which underwent 24-h ABPM, 24-h albumin excretion rate (AER) measurement and GFR estimation, using the CKD-EPI equation. The Max Slope BP was calculated as the first derivative of the curve obtained by fitting partial Fourier series to raw BP data recorded by discontinuous 24-h ABPM. Results: The Max Slope of systolic BP (SBP) was higher in subjects with SRD (n = 117) than in those without SRD (n = 272) .