Clinical Correlates of Ambulatory BP Monitoring among Patients with CKD

Iimuro, Satoshi; Imai, Enyu; Watanabe, Tsuyoshi; Nitta, Kosaku; Akizawa, Tadao; Matsuo, Seiichi; Makino, Hírofumi; Ohashi, Yasuo; Hishida, Akira

doi:10.2215/cjn.06470612

Cited by 63 publications

(68 citation statements)

References 44 publications

(32 reference statements)

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“…The prevalence of masked hypertension was similar in CRIC participants when compared with other cohorts of patients with CKD, such as in the African American Study of Kidney Disease and Hypertension Cohort Study and the CKD Japan Cohort, at 43% and 31% respectively (9,(27)(28)(29). However, in a meta-analysis by Agarwal et al and a crosssectional study from Spain, masked hypertension was present in less than 10% of CKD patients (30,31).…”

Section: Discussionmentioning

confidence: 63%

“…Earlier studies of CKD cohorts have shown an increased risk for masked and sustained hypertension with elevated urine protein, but analyses were unadjusted or obtained from small cohorts (9,27,33). In CRIC, masked hypertension was associated with low eGFR, and masked and sustained hypertension were associated with elevated urine protein, independent of other risk factors.…”

Section: Discussionmentioning

confidence: 99%

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Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

176

118

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Background and objectives Masked hypertension and elevated nighttime BP are associated with increased risk of hypertensive target organ damage and adverse cardiovascular and renal outcomes in patients with normal kidney function. The significance of masked hypertension for these risks in patients with CKD is less well defined. The objective of this study was to evaluate the association between masked hypertension and kidney function and markers of cardiovascular target organ damage, and to determine whether this relationship was consistent among those with and without elevated nighttime BP.Design, setting, participants, & measurements This was a cross-sectional study. We performed 24-hour ambulatory BP in 1492 men and women with CKD enrolled in the Chronic Renal Insufficiency Cohort Study. We categorized participants into controlled BP, white-coat, masked, and sustained hypertension on the basis of clinic and 24-hour ambulatory BP. We obtained echocardiograms and measured pulse wave velocity in 1278 and 1394 participants, respectively. ResultsThe percentages of participants with controlled BP, white-coat, masked, and sustained hypertension were 49.3%, 4.1%, 27.8%, and 18.8%, respectively. Compared with controlled BP, masked hypertension independently associated with low eGFR (23.2 ml/min per 1.73 m 2 ; 95% confidence interval, 25.5 to 20.9), higher proteinuria (+0.9 unit higher in log 2 urine protein; 95% confidence interval, 0.7 to 1.1), and higher left ventricular mass index (+2.52 g/m 2.7 ; 95% confidence interval, 0.9 to 4.1), and pulse wave velocity (+0.92 m/s; 95% confidence interval, 0.5 to 1.3). Participants with masked hypertension had lower eGFR only in the presence of elevated nighttime BP (23.6 ml/min per 1.73 m 2 ; 95% confidence interval, 26.1 to 21.1; versus 21.4 ml/min per 1.73 m 2 ; 95% confidence interval, 26.9 to 4.0, among those with nighttime BP ,120/70 mmHg; P value for interaction with nighttime systolic BP 0.002).Conclusions Masked hypertension is common in patients with CKD and associated with lower eGFR, proteinuria, and cardiovascular target organ damage. In patients with CKD, ambulatory BP characterizes the relationship between BP and target organ damage better than BP measured in the clinic alone.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Drawz¹,

Alper²,

Anderson³

et al. 2016

Clinical Journal of the American Society of Nephrology

176

118

View full text Add to dashboard Cite

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“…How reliable is office assessed blood pressure in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, as it was shown before that office BP tends to overestimate blood pressure control in renal transplantation [3]. On the other hand, ambulatory blood pressure monitoring (ABPM) seems to offer a more reliable view over arterial hypertension both in CKD and KTx patients [4][5] and also a prognostic superiority [6]. Due to the pro-hypertensive potential of immunosuppressive drugs [7][8], blood pressure control is one of the major targets for outcome management in KTx patients [9].…”

Section: Introductionmentioning

confidence: 99%

Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

Tarta

Denise

Tarta

et al. 2015

Acta Medica Marisiensis

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How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients. We conducted a prospective study which enrolled 45 patients. Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits. A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. Office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups.

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“…In the general population, data consistently show that the lack of recognition of high BP outside the clinic-masked hypertension-is associated with increased cardiovascular damage 8,12 and cardiovascular morbidity and mortality. 9,[13][14][15][16][17][18] Although emerging data in CKD also support this concept, [19][20][21][22][23][24][25][26][27][28] whether patients with CKD also have a high prevalence of MHTN, and if so what the determinants of this condition are, and how reproducible this diagnosis is, remains to be demonstrated prospectively in studies dedicated to this purpose. Furthermore, the ability of home BP to diagnose MHTN and its reproducibility remains scarcely studied even in the general population.…”

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confidence: 99%

Masked Uncontrolled Hypertension in CKD

Agarwal

Pappas

Sinha

2016

Journal of the American Society of Nephrology

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Masked uncontrolled hypertension (MUCH) is diagnosed in patients treated for hypertension who are normotensive in the clinic but hypertensive outside. In this study of 333 veterans with CKD, we prospectively evaluated the prevalence of MUCH as determined by ambulatory BP monitoring using three definitions of hypertension (daytime hypertension $135/85 mmHg; either nighttime hypertension $120/70 mmHg or daytime hypertension; and 24-hour hypertension $130/80 mmHg) or by home BP monitoring (hypertension $135/ 85 mmHg). The prevalence of MUCH was 26.7% by daytime ambulatory BP, 32.8% by 24-hour ambulatory BP, 56.1% by daytime or night-time ambulatory BP, and 50.8% by home BP. To assess the reproducibility of the diagnosis, we repeated these measurements after 4 weeks. Agreement in MUCH diagnosis by ambulatory BP was 75-78% (k coefficient for agreement, 0.44-0.51), depending on the definition used. In contrast, home BP showed an agreement of only 63% and a k coefficient of 0.25. Prevalence of MUCH increased with increasing clinic systolic BP: 2% in the 90-110 mmHg group, 17% in the 110-119 mmHg group, 34% in the 120-129 mmHg group, and 66% in the 130-139 mmHg group. Clinic BP was a good determinant of MUCH (receiver operating characteristic area under the curve 0.82; 95% confidence interval 0.76-0.87). In diagnosing MUCH, home BP was not different from clinic BP. In conclusion, among people with CKD, MUCH is common and reproducible, and should be suspected when clinic BP is in the prehypertensive range. Confirmation of MUCH diagnosis should rely on ambulatory BP monitoring. CKD affects 11% (19.2 million) of the United States adult population; 1,2 among them hypertension occurs in at least 70%. 3 Controlling hypertension is an important strategy to reduce cardiovascular morbidity and mortality and end-stage renal disease. Yet some large randomized trials that have lowered BP have failed to show an improvement in cardiovascular or renal outcomes. [4][5][6] One explanation may be that techniques to assess BP in these patients were suboptimal. Whereas non-traditional risk factors may certainly be important, data from the Framingham Heart Study demonstrate that it is the traditional risk factors that mediate the inflammatory state; this in turn impairs vascular function. 7 Thus, it appears appropriate to refocus our attention on the traditional risk factorssuch as blood pressure-and how to better assess and treat hypertension.Masked hypertension (MHTN), which is defined as normal BP in the clinic but elevated BP at home is seen in 10-20% of the general population that does not receive antihypertensive therapy. 8,9 A meta-analysis of 36 studies incorporating 25,629 participants reported its prevalence as 17%. 10 People receiving antihypertensive therapy who have hypertension out of office but have normal BP in the clinic are said to have masked uncontrolled hypertension (MUCH). In studies of CKD patients, all of which recruited a limited number of patients, a meta-analysis also found a high prevalence of MUCH. 11 Th...

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Clinical Correlates of Ambulatory BP Monitoring among Patients with CKD

Cited by 63 publications

References 44 publications

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Masked Hypertension and Elevated Nighttime Blood Pressure in CKD

Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

Masked Uncontrolled Hypertension in CKD

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