2020-08-012024-05-15https://scholars.lib.ntu.edu.tw/handle/123456789/666222The blood pressure variability (BPV) could be classified as very short term (beat-to-beat), short term (within 24 hour), mid-term (day-by day) and very long term (visit-to-visit). Different time scale BPV has been related to chronic kidney diseases (CKD) recently. From the Spanish Ambulatory-Blood-Pressure Monitoring Registry using short-term BPV, patients with CKD have significantly higher systolic blood pressure standard deviation, weighted standard deviation, coefficient of variation and lower diastolic pressure standard deviation compared with those without CKD (P < 0.001). Using mid-term BPV, Day-by-day variability of morning SBP is proven as an independent predictor for progression to macro-albuminuria in patients with type 2 diabetes. Using ling-term BPV, higher visit-to-visit BPV is independently associated with higher rates of death and hemorrhagic stroke in patients with moderate to advanced CKD not yet on dialysis. In ALLHAT study, higher visit-to-visit BPV is associated with higher risk of renal outcomes included incident ESRD or ≥50% decline in eGFR after randomization. In a Japan study, among those in the middle-aged and elderly general population without diabetes mellitus, long-term BPV during 3 years is associated with new-onset CKD risk, independently of mean or cumulative exposure to BP and metabolic profile changes during follow-up. The Telehealth center of National Taiwan University Hospital has been established since 10 years ago with more than 3800 users and 4.16 million data transmission. We have reported that the 4th generation synchronous tele-health program achieves better cost-effectiveness and clinical outcomes in patients with chronic cardiovascular diseases. This tele-health program is also associated with less all-cause mortality compared with usual care after adjusting for chronic comorbidities. Our study has showed a triphasic relationship between contract compliance rate to the telehealth program and risk of hospitalization. We analyzed a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. The aims of this study are to assess the effects of different time scale of BPV from the 4th generation Telehealth platform on cardiovascular outcomes of CKD patients (all cause admission, re-admission duration, cardiovascular admission, cardiovascular admission duration, frequency of visiting emergency station, all cause mortality and cardiovascular mortality). In the first year, we will collect the previous demographic recordings, BP measurements, co-morbidities, medications, CHA2DS2-VASc scores, and clinical events from data bank of Telehealth Center and integrated with different time scale BPV. In the second year, the data of wearable cuff-less BP and heart rate will be incorporated with telehealth platform. In the third year, these data will be used these BPV parameters from wearable cuff-less BP to validate the results of the first year study .Synchronous Tele-healthBlood pressure variabilityChronic kidney diseasesPrognosis of cardiovascular diseases