{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T07:36:29Z","timestamp":1785828989058,"version":"3.56.0"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Blood pressure (BP) variability has been increasingly recognized as a predictor of cardiovascular and renal outcomes. However, the relevance of specific dynamic indices such as the maximum slope of systolic blood pressure (max SBP slope), derived through partial Fourier series modeling, in relation to early renal damage remains underexplored. Methods: A total of 389 patients with essential hypertension were enrolled and stratified according to the estimated glomerular filtration rate (eGFR) \u2265 or &lt;90 mL\/min\/1.73 m2 and the presence of subclinical renal damage, defined by elevated urinary albumin excretion (AER) and\/or reduced eGFR. All participants underwent clinical and biochemical evaluation, as well as 24-h ambulatory blood pressure monitoring (ABPM), including advanced hemodynamic analysis using Fourier-based modeling. Results: Patients with eGFR &lt; 90 mL\/min\/1.73 m2 were older and exhibited higher waist circumference, uricemia, albuminuria, and systolic BP values, including the elevated max SBP slope (12.8 vs. 10.8 mmHg\/h, p = 0.028). Subclinical renal damage was associated with older age; male sex; smoking; and higher levels of uricemia, clinical, and ambulatory BP, and the max SBP slope (14.2 vs. 10.7 mmHg\/h, p = 0.007). The max SBP slope positively correlated with AER (r = 0.215, p &lt; 0.001) and inversely with eGFR (r = \u22120.153, p = 0.002). In multivariate linear regression, the max SBP slope remained independently associated with AER (\u03b2 = 0.220, p &lt; 0.001), along with mean 24-h SBP, male sex, and the day\u2013night SBP percentage dip. Logistic regression confirmed these associations with subclinical renal damage (max SBP slope OR: 1.536; 95% CI: 1.241\u20132.004; p = 0.001). Conclusions: The max SBP slope, a dynamic index of BP derived via Fourier analysis, is independently associated with markers of subclinical renal damage in hypertensive patients. This suggests that incorporating such advanced metrics into ABPM evaluation may improve early risk stratification and help identify individuals at greater risk of renal impairment, even in the absence of overt kidney disease.<\/jats:p>","DOI":"10.3390\/life15071149","type":"journal-article","created":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T13:59:11Z","timestamp":1753106351000},"page":"1149","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Relationship Between Subclinical Renal Damage and Maximum Rate of Blood Pressure Variation Assessed by Fourier Analysis of 24-h Blood Pressure Curve in Patients with Essential Hypertension"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6767-8823","authenticated-orcid":false,"given":"Caterina","family":"Carollo","sequence":"first","affiliation":[{"name":"Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Sorce","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Giovanna","family":"Vario","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4934-0818","authenticated-orcid":false,"given":"Emanuele","family":"Cirafici","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Bologna","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8245-9219","authenticated-orcid":false,"given":"Maria Elena","family":"Ciuppa","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"Evola","sequence":"additional","affiliation":[{"name":"Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8500-8671","authenticated-orcid":false,"given":"Guseppe","family":"Mul\u00e8","sequence":"additional","affiliation":[{"name":"Unit of Nephrology and Dialysis, Hypertension Excellence Centre, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-1151","authenticated-orcid":false,"given":"Giulio","family":"Geraci","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, \u201cKore\u201d University of Enna, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1038\/s41581-019-0244-2","article-title":"The global epidemiology of hypertension","volume":"16","author":"Mills","year":"2020","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1874","DOI":"10.1097\/HJH.0000000000003480","article-title":"ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA)","volume":"41","author":"Burnier","year":"2023","journal-title":"J. Hypertens."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1038\/s41569-021-00559-8","article-title":"Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension","volume":"18","author":"Zhou","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1056\/NEJMoa1803180","article-title":"Effect of Systolic and Diastolic Blood Pressure on Cardiovascular Outcomes","volume":"381","author":"Flint","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1007\/s11606-022-08001-6","article-title":"Blood Pressure Variability and the Progression of Chronic Kidney Disease: A Systematic Review and Meta-Analysis","volume":"38","author":"Yang","year":"2023","journal-title":"J. Gen. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hanevold, C.D., Seo, J.D., Daniels, S.R., Falkner, B.E., Ferguson, M.A., Flynn, J.T., Ingelfinger, J.R., Khoury, P.R., Lande, M.B., and Meyers, K.E. (Pediatr. Nephrol., 2025). Ambulatory blood pressure variability in prediction of target organ injury: The SHIP AHOY study, Pediatr. Nephrol., Online ahead of print.","DOI":"10.1007\/s00467-025-06803-4"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1038\/hr.2011.170","article-title":"The impact of visit-to-visit variability in blood pressure on renal function","volume":"35","author":"Kawai","year":"2012","journal-title":"Hypertens. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/HJH.0b013e328336ed09","article-title":"Combined effect of albuminuria and estimated glomerular filtration rate on cardiovascular events and all-cause mortality in uncomplicated hypertensive patients","volume":"28","author":"Viazzi","year":"2010","journal-title":"J. Hypertens."},{"key":"ref_9","first-page":"1","article-title":"Impact of microalbuminuria on incident coronary heart disease, cardiovascular and all-cause mortality: A meta-analysis of prospective studies","volume":"8","author":"Xia","year":"2015","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Chronic Kidney Disease Prognosis Consortium, Matsushita, K., van der Velde, M., Astor, B.C., Woodward, M., Levey, A.S., de Jong, P.E., Coresh, J., and Gansevoort, R.T. (2010). Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: A collaborative meta-analysis. Lancet, 375, 2073\u20132081.","DOI":"10.1016\/S0140-6736(10)60674-5"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/MNH.0b013e32835b36c1","article-title":"Renal microvascular dysfunction, hypertension and CKD progression","volume":"22","author":"Bidani","year":"2013","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e12661","DOI":"10.1111\/micc.12661","article-title":"Microvascular dysfunction and kidney disease: Challenges and opportunities?","volume":"28","author":"Krishnan","year":"2021","journal-title":"Microcirculation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1201","DOI":"10.1002\/sim.4780131203","article-title":"A Fourier series approach for comparing groups of subjects on ambulatory blood pressure patterns","volume":"13","author":"Somes","year":"1994","journal-title":"Stat. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1111\/jch.14210","article-title":"Should reduction of increased short-term blood pressure variability be a target of antihypertensive therapy?","volume":"23","author":"Sorce","year":"2021","journal-title":"J. Clin. Hypertens."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1038\/s41569-022-00690-0","article-title":"Blood pressure and its variability: Classic and novel measurement techniques","volume":"19","author":"Schutte","year":"2022","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1111\/jch.13638","article-title":"Self-blood pressure monitoring as a tool to increase hypertension awareness, adherence to antihypertensive therapy, and blood pressure control","volume":"21","author":"Giuseppe","year":"2019","journal-title":"J. Clin. Hypertens."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1111\/jch.13871","article-title":"From short-term blood pressure variability to atherosclerosis: Relative roles of vascular stiffness and endothelial dysfunction","volume":"22","author":"Tatasciore","year":"2020","journal-title":"J. Clin. Hypertens."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40885-023-00248-3","article-title":"Short-term blood pressure variability as a potential therapeutic target for kidney disease","volume":"29","author":"Ko","year":"2023","journal-title":"Clin. Hypertens."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1007\/s11906-013-0401-0","article-title":"Blood Pressure Control and Primary Prevention of Stroke: Summary of the Recent Clinical Trial Data and Meta-Analyses","volume":"15","author":"Gaciong","year":"2013","journal-title":"Curr. Hypertens. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e025641","DOI":"10.1161\/JAHA.122.025641","article-title":"Prevalence of Isolated Nocturnal Hypertension and Development of Arterial Stiffness, Left Ventricular Hypertrophy, and Silent Cerebrovascular Lesions: The KoGES (Korean Genome and Epidemiology Study)","volume":"11","author":"Kim","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"R1153","DOI":"10.1152\/ajpregu.00402.2005","article-title":"Renal autoregulation: New perspectives regarding the protective and regulatory roles of the underlying mechanisms","volume":"290","author":"Loutzenhiser","year":"2006","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"F429","DOI":"10.1152\/ajprenal.00500.2020","article-title":"Restoration of afferent arteriolar autoregulatory behavior in ischemia-reperfusion injury in rat kidneys","volume":"320","author":"Feng","year":"2021","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mizdrak, M., Kumri\u0107, M., Kurir, T.T., and Bo\u017ei\u0107, J. (2022). Emerging Biomarkers for Early Detection of Chronic Kidney Disease. J. Pers. Med., 12.","DOI":"10.3390\/jpm12040548"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2473","DOI":"10.1056\/NEJMra054415","article-title":"Assessing kidney function--measured and estimated glomerular filtration rate","volume":"354","author":"Stevens","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1161\/HYPERTENSIONAHA.120.15394","article-title":"Long-Term Blood Pressure Variability in Young Adulthood and Coronary Artery Calcium and Carotid Intima-Media Thickness in Midlife: The CARDIA Study","volume":"76","author":"Nwabuo","year":"2020","journal-title":"Hypertension"},{"key":"ref_26","first-page":"739","article-title":"Relationship between blood pressure variability and carotid artery damage in hypertension","volume":"24","author":"Mancia","year":"1994","journal-title":"Hypertension"},{"key":"ref_27","first-page":"273","article-title":"Prognostic significance of blood pressure variability in individuals with and without hypertension: The Ohasama study","volume":"27","author":"Kikuya","year":"2000","journal-title":"Hypertens. Res."},{"key":"ref_28","first-page":"279","article-title":"Subclinical kidney damage in hypertensive patients: A renal window opened on the cardiovascular system. Focus on microalbuminuria","volume":"956","author":"Castiglia","year":"2017","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Massierer, D., Leiria, L.F., Severo, M.D., Ledur, P., Dos, S., Becker, A.D., Aguiar, F.M., Lima, E., Freitas, V.C., and Schaan, B.D. (2016). Blood pressure variability and its association with echocardiographic parameters in hypertensive diabetic patients. BMC Cardiovasc. Disord., 16.","DOI":"10.1186\/s12872-015-0183-1"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1038\/hr.2012.145","article-title":"Impact of visit-to-visit variability of blood pressure on deterioration of renal function in patients with non-diabetic chronic kidney disease","volume":"36","author":"Kario","year":"2013","journal-title":"Hypertens. Res."},{"key":"ref_31","first-page":"607","article-title":"Visit-to-visit blood pressure variability: A review of the literature","volume":"19","author":"Mena","year":"2017","journal-title":"J. Clin. Hypertens."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1097\/01.hjh.0000160205.81652.5a","article-title":"A reliable index for the prognostic significance of blood pressure variability","volume":"23","author":"Mena","year":"2005","journal-title":"J. Hypertens."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1038\/nrcardio.2013.1","article-title":"Assessment and management of blood-pressure variability","volume":"10","author":"Parati","year":"2013","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_34","first-page":"393","article-title":"Blood pressure variability and cardiovascular risk: Current evidence and clinical implications","volume":"36","author":"Kario","year":"2013","journal-title":"Hypertens. Res."},{"key":"ref_35","first-page":"720","article-title":"Glomerular hemodynamics and albuminuria: Mechanisms and therapeutic implications","volume":"13","author":"Tonneijck","year":"2017","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_36","first-page":"375","article-title":"Ambulatory blood pressure monitoring: Clinical relevance of blood pressure variability and circadian rhythm","volume":"36","author":"Hermida","year":"2013","journal-title":"Hypertens. Res."},{"key":"ref_37","first-page":"1249","article-title":"Ambulatory blood pressure monitoring: Indications and interpretation","volume":"20","author":"Parati","year":"2018","journal-title":"J. Clin. Hypertens."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/7\/1149\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:25Z","timestamp":1760033605000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/7\/1149"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["life15071149"],"URL":"https:\/\/doi.org\/10.3390\/life15071149","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,21]]}}}