Blood pressure (BP) is a periodic phenomenon consisting of two components: steady and pulsatile. Recent studies in the late 2000 suggest that Pulse Pressure (PP) is a strong predictor of cardiovascular end points, and is perhaps stronger than MAP, SBP and DBP.1 PP is important independent prognostic markers of cardiovascular morbidity and mortality.2 However still, the normal range of PP is not known.
Chronic kidney disease (CKD) is a significant global problem creating an increasing worldwide health and economic burden. As CKD is usually silent until its late stages, many patients are detected only shortly before the onset of symptomatic kidney failure when there are few opportunities to prevent adverse outcomes.3 Proteinuria and albuminuria are the earliest markers of kidney damage in patients with diabetes, hypertension and glomerular diseases, and persistent increases in levels are the most common markers of kidney damage in adults.3 The CARI Early CKD Working Group prefers albuminuria because it accurately predicts renal and cardiovascular risks, exhibits greater sensitivity for detecting lower, clinically important proteinuria.3
The authors intend to conduct observational cross-sectional study regarding BP components in conjunction with early sign of worsening renal failure in all cardiac patients without previous history of renal disease and diabetes. There were 493 valid samples to be analyzed using SPSS-21 program.
Bivariate Pearson Correlation in all samples yielded equivalent significant low positive correlation among those blood pressure components towards occurrence of microalbuminuria. Moreover, when samples with diabetes were excluded, only SBP and PP gave significant high positive correlation towards microalbuminuria (R = .721; p = .008 and R = .711; p = .010 respectively). Surprisingly, the very high positive correlation between PP and microalbuminuria has only proven significant in group with PP > 60 mmHg (R = .992; p = .008). In samples with normal BP, Spearman correlation revealed significant high negative correlation of DBP and MAP towards microalbuminuria when SBP and PP gave significant positive correlation towards proteinuria in other samples with hypertension.
As final words, to the extent of the author knowledge, this is the first study in Indonesia that prove higher PP as independent risk of early sign of worsening renal failure, in all patients regardless of their blood pressure level. Pulse pressure more than 60 mmHg in non-diabetic samples was able to express its very high positive correlation towards incidence of microalbuminuria. DBP and MAP showed to be important towards microalbuminuria in normotensive group, as SBP and PP in hypertensive group. Hence, more study needed to get other evidences on the role of blood pressure component in worsens the renal function in order to get better management approach.